Stroke Prevention in the Wisconsin Native American Population

At a Glance

This project, Stroke Prevention in the Wisconsin Native American Population, aimed to establish a stroke prevention program for Wisconsin’s Native American population as this community faces higher rates of stroke, coronary artery disease, and associated risk factors compared to other racial groups. Despite challenges due to the COVID-19 pandemic, the researchers successfully engaged the Native American community with web-based education and a wellness coach who was based on the reservation. Preliminary data showed a greater need for stroke prevention than initially expected, with approximately 80 percent of tribe elders at increased risk for stroke and 50 percent having diabetes. The project has received bridge funding to support their work while seeking additional funding for the long-term continuation of the stroke prevention program.

The Challenge

Stroke, coronary artery disease and their risk factors are significantly higher in Wisconsin’s Native American individuals compared to other racial groups. Stroke is the fifth leading cause of death in Native Americans, and stroke incidence is 14 percent higher in this population than in other racial groups. Native Americans show a higher burden of hypertension, diabetes, coronary heart diseases and smoking. As a result, there is a need to identify and target both traditional and novel stroke risk factors in the Native American population.

Project Goals

The overarching goal of this project was to establish a stroke prevention program for the Wisconsin Native American population through a partnership with Oneida Comprehensive Health Division. This goal was addressed through two specific aims:

1. Implement and assess an intense intervention to prevent stroke and vascular cognitive decline (changes to memory, thinking and behavior caused by damage to the brain’s blood vessels) in this population.
2. Test new biological indicators that may be useful to improve existing tools to predict stroke risk and monitor the success of preventive interventions in the Native American and other populations.

Results

Despite challenges presented by the COVID-19 pandemic, this project successfully identified innovative methods to continue this work. The researchers developed web-based educational programming on Facebook Live and hired a wellness coach who was an Oneida Health Division employee based on the reservation. The wellness coach had ties to the community and helped create and promote educational videos about healthy cooking and fitness routine using everyday items. More than 2,800 people attended the project’s community education and Facebook Live events. These efforts and the involvement of eight UW Native American medical students helped build trust in the community and allowed researchers and students to continue engaging the tribe in educational activities.

In March 2021 researchers were allowed back on the reservation and achieved full enrollment of 120 participants. Of those participants, 119 completed baseline studies (100 Native American individuals who are at high risk for stroke and 19 who are considered at low risk for stroke). They achieved nearly 100 percent retention of study participants as 117 participants are planning to complete their 2-year visits. Baseline and 2-year visit study activities include:

• Ultrasound examination to assess the buildup of cholesterol and other deposits in blood vessels.
• Neurocognitive testing which involved various tasks and questions to evaluate memory, attention, problem-solving and other mental abilities.
• A general health assessment with a physician.
• A health resource conversation with a wellness coach.
• Blood testing to evaluate biological indicators of stroke including glucose, cholesterol and ribonucleic acid analysis.

Preliminary data have shown there is a greater need for stroke prevention programming than initially thought. Researchers expected between 39 and 69 percent of tribe elders to have premature atherosclerotic disease, a precursor to stroke, based on their age, but they found that approximately 80 percent of the tribe elders are at increased risk for stroke. These studies also revealed that approximately 50 percent of tribe elders have diabetes. Personal health coaches were assigned to 51 participants to address their individual risk factors.

Looking to the Future

Researchers plan to continue their partnership with Oneida Comprehensive Health Division and are seeking additional funding to carry on this stroke prevention program.