Strokes Prevalent Among Asians/Asian Americans - NEMC Participates in National Stroke Clinical Tests
by Lillian Chan


The National Institutes of Health (NIH) is funding a nationwide clinical trial for better treatment of secondary strokes. The Tufts Comprehensive Stroke Center at the New England Medical Center (NEMC) is among the many hospitals and clinics participating in this test.

The American Stroke Association reports that stroke is the third leading killer, behind heart and cancer, and is also the leading cause of disability in our nation. Those prone to the disease are those who have had a stroke before, are over the age of 60, and/or male.

Also, according to David E. Thaler, M.D., of the Department of Neurology at NEMC, stroke affects 6%-29% of African Americans, 11%-22% of Asians and Asian Americans, 11% of Hispanics, and 6%-10% of Caucasians. The differences in race though may be due in part to high blood pressure and dietary differences as reported by The Internet Stroke Center at Washington University.

Strokes occur when a blood vessel or an artery is blocked. It can also occur when a blood vessel breaks. Both of these instances interrupt blood flow to the brain, which kills brain cells within the immediate area. Without prompt medical treatment, brain cells within the larger area will die as well.

According to Thaler, 80% of strokes are caused by blockage, while the other 20% are caused by hemorrhages, or bleeding. The blockage can occur when there is a plaque build up in the carotid artery in the neck. That build up can travel through the bloodstream to the brain. Once in the brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causes a stroke.

This type of blockage seems to be prevalent among those in the Asian and Asian American community. The interesting aspect Thaler noted is that this type of stroke is not common in Asian countries such as Japan, China, or Vietnam. Rather, as you get closer to the United States, the problem arises. Therefore, Asians in Hawaii have occurrences of strokes as well, but not as high a degree as those on the mainland. A possible theory for this phenomenon may be in the diet.

It wasn't until December of 1995 that stroke became treatable thanks in part to a "clot busting" drug -- Tissue Plasminogen Activator or TPA -- that had been used for heart attacks up to that point.

The TPA drug must be administered quickly if it is to have any affect. The window of opportunity is three hours from the time the patient was last healthy. For example, if someone had a stroke and he or she was last seen healthy at 7:30 pm enjoying a meal, then the drug would need to be administered at 10:30 pm. Therefore, it is crucial that the stroke victim be taken to the emergency room as quickly as possible.

But, fewer than 5% who are eligible for this drug don't get it because they wait too long. Why do some people wait too long? Most don't know the basic symptoms and warning signs of a stroke, which are:
  • sudden numbness or weakness of face, arm or leg, especially on one side of the body.
  • sudden confusion, trouble speaking or understanding.
  • sudden lack of seeing in one or both eyes.
  • sudden trouble walking, dizziness, loss of balance or coordination.
  • sudden, severe headache with no known cause.
Also, many make the mistake of calling their doctor or family member for help. The most important thing to do is to call 911 for emergency treatment. "People need to understand that stroke is a brain disease," said Thaler. He also stressed the fact that a stroke is a "brain attack" and needs the same response and attention as a heart attack.

There are ways to reduce the chances for having a stroke such as making lifestyle changes (i.e. lowering high blood pressure, quitting smoking, reducing alcohol intake, controlling diabetes, lowering high cholesterol, and exercising). For those who have had a stroke before, it is important that you figure out with your doctor why you had one so that your chances of having another one will be greatly reduced.

The two treatments currently being used for patients are aspirin and a blood-thinning drug called Coumadin, which can cause an increase in bleeding.

NIH is funding clinical tests to determine which treatment is more successful. In the clinical tests, half of the patients participating in this study who have had secondary strokes will take the aspirin, while the other half will take Coumadin. The tests will offer patients detailed neurological follow-up and medications at no cost. Interpreters in Cantonese, Mandarin, Japanese, and Vietnamese are at hand to assist.

If anyone would like more information on these clinical tests, please contact Tom Scandura, Nurse Practioner, at (617) 636-7591.

For more information on strokes, visit these websites:

printed in the Sampan, New England's Only Chinese-English Newspaper, on October 20, 2000

copyright © 2003 Lillian Chan. All Rights Reserved.
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