Abstract T MP64: John Henryism, Race-Ethnicity and Stroke Risk: Pilot Findings From the DESERVE Trial

Abstract

Background: Stroke is characterized by race-ethnic disparities in incidence, recurrence and mortality. Little work has examined stroke disparities within a psychosocial context. John Henryism (JH) is a construct which describes an individual’s self-perception that they can overcome the demands of their environment through hard work and determination. At high levels, JH is associated with HTN in African Americans with limited education. Aim: This study aims to assess the relationship between High JH and burden of stroke risk markers in a multiethnic mild stroke/ TIA cohort. Methods: As part of the ongoing DESERVE trial, we collected baseline demographics, medical hx, psychosocial and physical assessments. JH was assessed using an 8-item likert scale. Risk burden included waist circumference >40 in for men and >35 in for women; BMI>30; hdl <40 mg/dL for men and <50 mg/dL for women, triglycerides ≥150 mg/dL, HTN, and diabetes. Metabolic syndrome was defined using ATP III criteria. We examined bivariate relationships between JH, demographics, and vascular outcomes using the students-t and chi-squared tests, as appropriate. We explored the interaction between JH and education on vascular risk factor distribution. Results: In a pilot sample of 121 DESERVE participants; mean age of 64.1 years; 49% were male, 28% with <HS education; 20% were White, 41% Black and 33% Hispanic. Risk burden was high with over 80% of the cohort hypertensive. Blacks and Hispanics were significantly more likely to have diabetes (p= 0.002); abdominal obesity (p=0.01) and metabolic syndrome (p=0.02). Median JH score was 20, out of a possible range of 1 - 24. We observed a marginally significant association between JH and race/ethnicity with higher proportions of High JH among Blacks and Hispanics (p=0.06), as well as non-significant trends of High JH among younger participants and those with <HS education (30% vs. 26%, p=0.6). Conclusion: Preliminary findings from DESERVE suggest that the burden of risk factors among multi ethnic stroke survivors may be positively associated with JH. Focus on risk reduction efforts without accounting for social determinants may lead to ineffective interventions.