Use of American Heart Association/American Stroke Association Secondary Stroke Prevention Recommendations in Hispanic/Latino Adults With Stroke/TIA: The Hispanic Community Health Study/Study of Latinos.

Background: Population studies showed that Hispanic/Latino adults have elevated rates of uncontrolled cardiovascular risk factors (CVRFs) with noticeable sex-specific variations . We investigated prevalence of CVRFs and the use of American Heart Association (AHA) secondary stroke prevention strategies in Hispanics/Latinos in the United States. Methods: Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were used to examine sociodemographic characteristics, use of antithrombotic agents and statins, and treatment of CVRFs in persons with a history of stroke or transient ischemic attack (TIA). CVRFs were categorized as “controlled” if the CVRF met the goals defined by the AHA irrespective of whether the subject was on treatment for it or not; and “unaware” if the participant denied having a CVRF but met the diagnostic criteria for it. Differences between men and women were tested using ANOVA test and Pearson’s χ 2 . Factors associated with adherence to AHA recommendations were investigated using logistic regression. Results: These analyses included 404 individuals with history of stroke/TIA (men=159; women=245). Women were slightly older than men (55.1±1.5 vs. 54.1±1.6 years; p<0.0001). The prevalence of hypertension (HTN), hypercholesterolemia (HC), and diabetes (DM) were 59%, 65% and 39%. The rates of awareness/controlled CVRFs were 90%/49%, 75%/32%, and 83%/54% for HTN, HC, and DM, respectively. Approximately 49% of the individuals were on antithrombotic agents, 39% on statins, and 26% on dual treatment with antithrombotics and statins. Rates were comparable between men and women except for HC control which was lower in women (41±6% vs. 23±5%; p=0.02). In logistic regression analysis, older age was associated with poorer adherence to AHA recommendations. Female sex and residence >10 years in the US were associated with uncontrolled HC and DM, respectively. Conclusion: Hispanics/Latinos with stroke have elevated rates of awareness but suboptimal use of AHA secondary stroke prevention strategies. Older persons and women are vulnerable groups that may benefit from targeted interventions.