Prevent Return of Stroke Study

Twenty nine percent of the 700,000 strokes that occur yearly nationwide are among stroke
survivors. Blacks, both nationally and among Harlem residents, have a twofold increase in
recurrent strokes. Harlem Latinos have a threefold increase in risk relative to Whites.

Primary risk factors for recurrent stroke include hypertension, hyperlipidemia, and under
use of anti-thrombotic agents. Controlling risk factors are particularly challenging for
low-income, minority populations who lack resources needed to adhere to necessary therapies.
In Harlem, 72% of adults studied six months post stroke did not have these three risk
factors treated adequately.

We propose to evaluate a community-based recurrent stroke intervention, versus usual care,
at reducing primary risk factors for recurrent strokes while providing an effective,
low-cost, sustainable recurrent stroke prevention program in neighborhoods like Harlem,
whose residents bear a disproportionate burden of suffering from strokes. Specifically, we
propose:

1. To work with community site leaders to identify and recruit 600 adults in Harlem who
have sustained a stroke or TIA within the past 5 years, through local venues such as
senior centers and churches;

2. To conduct a randomized, controlled trial to determine if participation in a peer-led
stroke prevention program activates stroke and TIA survivors to improve their knowledge
and self-management strategies and treatments related to stroke prevention; and

3. To rigorously compare the impact of the intervention with usual care (delayed
intervention), on increasing the proportion of individuals with strokes and TIAs who
are appropriately treated to reduce the risk of recurrent events, specifically through
control of hypertension (blood pressure ≤ 140/90mmHg), hyperlipidemia (LDL
cholesterol≤100 mg/dl) and use of anti-thrombotic medicines.