3 things doctors can do to prevent strokes in Black patients, who have double the risk

• Stroke is the fifth leading cause of death in the United States, but is preventable.
• Black people are two times more likely to have a stroke than any other racial group.

Having a good doctor can turn a visit to a doctor's office from a dreaded affair into a tolerable one, and maybe even make it enjoyable. Attentive care can also lead to improved health long-term, including reducing risk of stroke.

Stroke is the fifth cause of death in the United States, and affects more than 795,000 people each year. Black adults are two times more likely to have a stroke than white adults, and Black people have the highest death rate from stroke than any other racial group, per the CDC.

There is no simple solution. Systemic racism impacts the health of Black Americans in myriad ways, from poor food access to worse medical care, as a group of leading doctors reported in an editorial for JAMA.

But there are some concrete steps doctors can take to reduce stroke risk, according to new research published August 3 in the journal, Stroke.

"There is a lot of disparity in the healthcare system in general," Dr. Eyad Almallouhi, a neurointerventionalist at Sarasota Memorial Hospital in Sarasota, Florida, and one of the study's lead authors, told Insider. "So what's important to know is, how can we minimize this disparity?"

Researchers looked at outcomes of Black patients compared to non-Black patients who participated in a study from 2008 to 2011, and found that attentive medical care not only reduced disparities, but prevented stroke going forward.

Here are three things doctors should be doing, according to Almallouhi and Dr. Ashley Nelson, co-author of the study and neurology resident at the Medical University of South Carolina in Charleston.

Design a personalized exercise and diet routine that patients can stick to

A stroke occurs when blood stops flowing to a part of the brain, leading to a lack of oxygen. Strokes can be fatal, or can lead to a permanent disability.

Patients in this study had "intensive lifestyle modification coaching, medication management, and had routine access to follow up," said Nelson, collectively known as "medical management." The original study found that medical management was more effective than a stent — a medical device that opens up narrowed arteries — at preventing future strokes.

At the start of the study, Black patients were less physically active than non-Black patients, and were more likely to have type 2 diabetes, high cholesterol and high blood pressure — also known as hypertension — all risk factors for stroke.

But that shifted after one year of medical management, and key stroke risk disparities between Black patients and all other patients had largely disappeared.

Specifically, medical management eliminated differences in patients' diastolic blood pressure, which is a good marker of cardiovascular health, and significantly increased physical activity.

Ultimately, the researchers said medical management also eliminated disparities in future stroke or death for Black patients.

More frequent follow-up visits for Black patients at risk of stroke

One "helpful" feature of the study, Almallouhi said, was "having close follow-ups with patients to be able to monitor and make sure their risk factors are under good control."

Over the course of this study, patients had more frequent check-ups than most Americans, per CDC data — five doctor's visits during the course of a year. That included their initial visit, and a 30-day, four-month, eight-month and 12-month follow-up visit.

The frequency of visits allowed doctors to see how well each patient's treatment plan was working. If a patient's blood pressure was still high, for example, at a follow-up visit, doctors could adjust their medication to help bring it into a healthy range. They also provided lifestyle coaching, to help patients improve their physical fitness.

Build a trustworthy environment

Almallouhi said that Black patients often face more barriers to accessing medical care than white patients, which can lead to disparities in health outcomes.

But there's also a question of trust. The American Heart Association (AHA) issued a "call to action" in 2020, acknowledging that "misdeeds conducted in the United States in the name of science and clinical care," have led to "mistrust and poor relationships" between people of color, including Black people, and the healthcare system.

It came shortly after an AHA study found that Black patients were less likely to seek medical help for stroke during the COVID-19 pandemic. For Almallouhi, it's clear that the onus is on healthcare professionals to rebuild that trust if they are to provide equal care.

Start by creating a safe and trustworthy environment for patients, Almallouni said. Good listening and communication skills will go a long way to help a doctor truly understand their patient's concerns. Doctors should make sure their patients understand why they are ordering certain tests, or prescribing a particular treatment.

"I think we have a long way to go to be able to achieve equal access for everyone," said Almallouni, but "highlighting the disparities and what we can do about them is very important to be able to move past these obstacles."