Effects of Acupuncture on Symptoms of Stable Angina: A Randomized Controlled Trial

The burden of stroke among US adults is the fifth leading cause of death and the leading cause of disability, costing an estimated $19 billion. Additionally, one-quarter of strokes that occur each year in the U.S. are recurrent events.78 A large, U.S. and U.K. multicenter trial focused on cardiovascular event recurrence evaluated 3,470 recent stroke patients and followed them for 2 years.81 African-American (AA) patients with recent stroke had an 60% higher risk of recurrent stroke compared to the general population.81 This difference was explained by substantially greater vascular risk in the AA patients and suggested that scientifically justified and targeted risk factor control post-stroke could improve heath outcomes among individuals at the very highest risk of stroke. The proposed project will test a curriculum-guided self-management support approach, TargEted MAnageMent (TEAM) focused specifically on high-risk men who have had cardiovascular events (stroke or transient ischemic attack/TIA). The project builds upon promising pilot data from 2 previous R21 projects. Novel project aspects include the: 1) Focus on high-risk men, 2) Use of Peer Dyads (stroke survivors and their care partners) as a key intervention component, 3) Use of curriculum-driven self-management, and 4) Investigation of mechanistic factors that may help explain the most salient experimental elements of TEAM. The proposed project is a 6-month prospective randomized controlled trial evaluating the effects of TEAM vs. wait-list (WL) control in high-risk men who have experienced a stroke or TIA within the past 10 years. The primary outcome is change in systolic BP, while secondary outcomes include diastolic BP, cholesterol, triglycerides and glycemic control for individuals with diabetes. An exploratory analysis will evaluate posited mechanistic attitudinal targets (stroke knowledge, self-efficacy, perceived social support) as well as proximal behaviors to reduce stroke risk including diet, exercise, smoking, and tobacco/substance use. A complementary qualitative assessment will evaluate the perspective of TEAM and WL participants. If pilot results can be confirmed, TEAM represents a practical approach suitable for broad scale-up to reduce the burden of stroke among individuals who are at high risk of experiencing a stroke event.