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Community intervention reduces stroke recurrence, improves survival For Release: Contact: For journal copies only, American Heart Association rapid access journal report: DALLAS, April 30 – Community efforts to identify and treat people with high blood pressure and to educate people about stroke risk factors can pay off in lower stroke death and recurrence rates, researchers report in today’s rapid access issue of Stroke: Journal of the American Heart Association. A new study of two communities in Beijing, China, showed that an intervention program that encouraged lifestyle changes and health screenings lowered the risk of stroke in a high-risk population compared to the control group. Principal investigator Bin Jiang, M.D., M.P.H., a professor of neuroepidemiology at the Beijing Neurosurgical Institute in Beijing, said previous studies found that death and disability from heart disease can be reduced through a combination of community health education and efforts to identify and treat people at increased risk. This study examined whether community intervention improves three-year survival and helps prevent recurrent stroke after an initial stroke. The issue is of particular urgency in China, where stroke is four times as common as heart attack, and in some areas is the leading cause of death. Researchers identified two geographically separate, urban communities in Chongwen and Xicheng districts, each with about 50,000 residents. “Both communities are in downtown Beijing and share the same access to medical care for acute stroke,” Jiang said. Only the Chongwen District, however, was the focus of a two-pronged health prevention effort spanning 1991 – 2000. In that community, directors of local resident committees (elected community residents charged with aiding many aspects of daily life, including public security and family planning) and medical workers regularly monitored the blood pressure of stroke patients and people with hypertension. They encouraged them to seek medical treatment for their conditions. Every three months, residents received flyers and bulletins with information on stroke, and occasional lectures were aimed at resident committee directors and patients with high blood pressure. The second prong of the intervention was an educational effort aimed at the entire Chongwen community. Various programs encouraged all residents to limit salt intake, exercise more often, quit smoking, and refrain from drinking alcohol – all lifestyle changes that can reduce the risk of stroke. Community surveys revealed that more than 90 percent of residents were influenced by the educational messages. There were no high blood pressure detection or management programs offered in the control community of Xicheng. Data on stroke and death from all causes were collected from the two areas. The risk of death from a first stroke was 26 percent lower in the intervention community than in the control community. The greatest decline occurred in the risk of death from hemorrhagic stroke, which was 39 percent lower. Hemorrhagic stroke is the result of bleeding, and carries a higher fatality rate than the more common ischemic stroke, which is the result of a blood-flow stoppage. “Community management of hypertension was a protective factor for surviving a stroke, especially hemorrhagic stroke,” Jiang said. Recurrence of stroke was tracked in people who experienced a first stroke in 1996 and 1997. During a three-year follow-up period, 52 (20.80 percent) of the 250 cases in the control community had a second stroke. Only 26 (11.66 percent) of the 223 cases in the intervention community had a second stroke. When the researchers analyzed various predictors for stroke recurrence, they found that the community intervention was the major protective factor. People were more likely to have a second stroke if their initial stroke was accompanied by vomiting or partial loss of sight, or if they had a history of transient ischemic attacks (TIA, or “mini-strokes”). Other well-known risk factors for stroke recurrence, such as heart disease, diabetes and high cholesterol, were found to be major risk factors in other studies but did not fully explain this study’s results. “Our study shows that community leaders can do something to help prevent cardiovascular disease,” Jiang said. Co-authors are Wen-zhi Wang, M.D.; Sheng-ping Wu, M.D.; Xiao-li Du, M.D.; and Qiu-ju Bao, M.D. Editor’s note: For more information on stroke, visit the American Stroke Association Web site: strokeassociation.org. ### NR04-1245 (Stroke/Jiang) Contact information: Dr. Jiang can be reached at 0086-10-670-16611, ext. 2662; bjyjiang@hotmail.com. (Please do not publish contact information.) |
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