May is National Stroke Awareness Month, a time to raise awareness about the symptoms and risk factors of stroke. The latter is so important as most strokes are thought to be preventable with lifelong control of risk factors, especially high blood pressure. This month is also an opportunity to recognize progress in advancing stroke research and care as well as opportunities for improving outcomes and health equity. Moreover, new efforts are underway to develop and test drugs that might protect brain tissue after stroke.
Stroke can happen to anyone, at any age. Do you know the warning signs of a stroke? Visit our Know Stroke webpage to explore and share toolkits, videos, brochures, and other stroke resources. Our colleagues at the American Stroke Association are also launching a host of resources for #StrokeMonth to help people learn about stroke.
In recent years, the biggest advances in stroke research have been in acute treatment of ischemic stroke. Restoration of brain blood flow (i.e., reperfusion therapy), during the minutes to hours immediately following the onset of stroke symptoms due to blocked blood vessels can prevent brain injury. Just last month, results from international clinical trials showed that removing a stroke-causing clot using special catheters that are inserted into the brain’s arteries has benefit for patients in preventing large strokes. These new results from endovascular treatment trials build on previous evidence and guidelines for clot-dissolving medication that can be injected quickly through a vein. Ongoing research is also focused on enhancing the benefit of intravenous therapies by combining more than one anti-clotting drug.
In addition to the success of endovascular therapies to return blood flow to the brain, researchers are also developing novel approaches to stroke recovery and rehabilitation. For example, brain and nerve stimulation therapies are being tested to help patients regain mobility, even many months after having a stroke. In an early study, researchers funded by the Brain Research Through Advancing Innovative Neurotechnologies® (BRAIN) Initiative adapted epidural spinal cord stimulation to restore arm and hand movement in two stroke patients. Researchers are also testing tele-rehabilitation strategies to help stroke survivors recover in their own homes.
Other efforts to develop novel treatments that may protect brain tissue and improve long-term outcomes after ischemic stroke are underway. Preclinical studies in animal models are bringing promising new neuroprotective drugs into the pipeline. The Stroke Preclinical Assessment Network (SPAN), the largest preclinical network in stroke, has designed a rigorous preclinical assessment to identify candidate drugs that might enhance the benefits of early reperfusion therapy in humans and encourages partnerships between researchers and industry, small businesses, or non-governmental organizations.
Ultimately, evidence needed to bring improved interventions for stroke prevention, treatment, and rehabilitation to people depends on rigorous, well-designed clinical studies. By connecting a nationwide network of hospitals, the NIH StrokeNet works to conduct clinical stroke trials faster and more efficiently. To explore innovative ways to further expand, optimize, and augment the use of endovascular therapies, StrokeNet is adding platform trials that will test several interventions in parallel. Additionally, the network is launching a new multi-center clinical study that will test the safety and efficacy of a novel investigational biologic agent developed with NINDS support that can be given in concert with reperfusion therapies, to reduce disability in subjects with moderate to severe acute ischemic stroke. If successful, this could be the first drug to treat acute stroke since 2003.
This Stroke Awareness Month, my strongest focus centers on awareness, prevention, and health equity. With a better understanding of stroke risk factors, we now know that stroke is largely preventable. But why are some people at a higher risk than others? For decades, NINDS has supported several longitudinal, population-based studies that have provided valuable insights into stroke risks and disparities. In 1990, the late Ralph Sacco, MD, MS, a renowned stroke neurologist and visionary leader, founded the Northern Manhattan Study (NOMAS), a landmark epidemiological study examining stroke risk factors among multi-ethnic populations living in the same community in Northern Manhattan, New York. NOMAS was one of the first to identify stroke disparities and has informed many stroke and cardiovascular disease prevention strategies we use today.
Another longstanding study, called REasons for Geographic and Racial Differences in Stroke (REGARDS), has enrolled more than 30,000 Black and White participants aged 45 and older in the southeastern part of the country with very high rates of cardiovascular disease and stroke, known as the “Stroke Belt.” The study helped us realize that a ‘one size fits all’ approach does not work for stroke prevention and that risk factor management should be tailored to patients based on their sex, race, and age. Last year, REGARDS researchers found that light-intensity physical activity, such as doing household chores and leisurely walks, can protect against stroke in older adults.
Other NINDS studies continue to answer important questions about stroke and raise awareness about stroke symptoms in populations most at risk. Stroke outcomes and disparities were exacerbated by the COVID-19 pandemic, making our focus on equity even more important. NINDS is tackling health disparities for stroke and other neurological conditions through strategic planning and other collaborative efforts. I recently highlighted a symposium and report led by the Brain Attack Coalition on improving equity in access to stroke care, from the emergency setting to inpatient hospital care.
High blood pressure or hypertension is a leading cause and controllable risk factor for stroke and for dementia later in life. Black men in their late 20s to mid-40s are at high risk for developing hypertension, and stroke is more common and deadly in middle-aged Black people compared to White people. Our Mind Your Risks® public health campaign encourages Black men to take charge of their health to reduce their risk of stroke and dementia. Over the past several months, we teamed up with Morehouse College to host two educational webinars for alumni and students, where Richard Benson, MD, PhD, Director of the NINDS Office of Global Health and Health Disparities, discussed tips for controlling high blood pressure, research updates, and other risk factors for stroke and dementia. NBC Sports Washington also helped us spread the word, and on May 17, World Hypertension Day, we joined the DC Metro HBCU Alumni Alliance for a Facebook Live chat on high blood pressure, stroke, and dementia. Mind Your Risks® is part of a national effort to make hypertension prevention, detection, and control more equitable. NINDS also participates on the Federal Hypertension Control Leadership Council, where we’re working on ways to increase self-monitoring for blood pressure.
With insights into stroke risk factors, more improved treatments on the way, and a focus on health equity, please join NINDS in promoting awareness about stroke this month and year-round. Together, I hope our work will inform new ways to improve the recovery process after stroke as well as prevent and treat stroke in all individuals and across the lifespan.