Stroke is the third leading cause of death in the United States, and African Americans are about 50 percent more likely to experience them than Caucasians. The odds are especially high for black men at 70 percent.

African Americans stroke survivors fare worse than other groups, too: They are more likely to become disabled by stroke and unable to participate in everyday activities like walking, lifting or grasping objects, and socializing with others.

What's the Problem?

African Americans generally have similar or even lower levels of total cholesterol than white and Hispanic Americans—relatively good news. Experts believe that the increased stroke risks result from a combination of genetic and environmental factors, such as high blood pressure (hypertension), diabetes, coronary heart disease, and a sedentary lifestyle—all major stroke risk factors.

African Americans Have More Stroke Risk Factors

More than 40 percent of African Americans have high blood pressure (defined as 140/90 mmHg or more); they tend to develop hypertension at an earlier age, and it usually is more severe and results in more complications.

African Americans are also more likely to be diagnosed with diabetes and coronary heart disease. And in 2009, African Americans were 50% more likely to be obese than non-hispanic whites; among black women, specifically, the odds were 60%.

Weight gain starts early: A 2007-2008 report showed that African American children ages 6 to 17 were already 30% more likely to be obese than non-hispanic whites. Obesity is itself a risk factor for stroke; it also contributes strongly to diabetes, high blood pressure, and high cholesterol.

African Americans Receive Less Medical Care

African Americans are also more likely to have a lower socioeconomic status, and so may be less likely to eat healthy, higher-priced foods; have health insurance; and get regular checkups that could potentially detect and treat hypertension before it escalates.

About one in 500 African Americans will also inherit sickle cell disease, a blood disorder that affects people of African, Caribbean, Mediterranean, Indian, and Central- and South-American descents and causes red blood cells to form into a sickle, or crescent shape. Strokes can occur when sickle cells get stuck in blood vessels and clog the flow of blood to the brain, as does happen in about 10% of children with sickle cell disease.

Stroke Education: Knowledge is Power

Even though African Americans are the population at highest risk, research shows that many don’t know very much about strokes. In a 2003 study of adults living near Cincinnati, Ohio, for example, elderly African American men had significant gaps in knowledge about stroke risk factors and warning signs, although they are a high-risk group.

Similarly, a 2010 study surveyed African Americans living in Mississippi about stroke symptoms, and found that many people did not know how lifestyle factors—such as lack of physical activity, excessive alcohol consumption, diabetes, smoking, and high cholesterol—contribute to stroke risk.

More than half also did not know that calling 911 right away was the most appropriate way to respond to stroke symptoms. And time does matter. If given within 3 hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) may reduce long-term disability for the most common type of stroke, according to the American Stroke Association.

The study authors determined that African-American communities need to be better educated about stroke risk, and suggest that black churches, schools, and the media play a crucial role in delivering information.

Protecting Your Health

Knowing your family history of stroke and its risk factors and communicating your racial and ethnic background to your doctor is an important part of determining your true stroke risk, especially because skin color and facial features aren’t always good indicators of your ethnic heritage.

The best ways to protect yourself are the same no matter what your race or ethnicity. Here's what you can do:

  • Be physically active.
  • Enjoy a low-sodium diet (Consume no more than 1,500 mg sodium per day).
  • Eat healthy foods low in saturated fat, trans fat, cholesterol.
  • Avoid drinking alcohol in excess.
  • Shed excess weight.
  • Don’t smoke.
  • Work with your doctor to manage high blood pressure, high blood sugar, and high cholesterol.
  • Ask whether you have atrial fibrillation or circulation problems—two additional risk factors for stroke.
  • See your doctor for a thorough checkup at least once a year.

Pass It On!

As you adopt healthy habits, encourage your family members and friends to take steps to prevent stroke. Together, you can help reverse the trend.

By: Amanda MacMillan


American Heart Association. What About African Americans and High Blood Pressure? Available at: Accessed: June 4, 2011.

American Stroke Association. Warning Signs. Available at: Accessed: June 16, 2011.

Centers for Disease Control and Prevention. Most Americans Should Consume Less Sodium (1,500 mg/Day or Less). Available at: Accessed: June 16, 2011.

Centers for Disease Control and Prevention. Sickle Cell Disease: Symptoms and Treatment. Available at: Accessed: June 4, 2011.

Centers for Disease Control and Prevention. Stroke Facts. Available at: Accessed: June 4, 2011.

Genetics Home Reference. What Is Sickle Cell Disease? Available at: Accessed: June 4, 2011.

National Stroke Assocation. African Americans and Stroke Brochure. Available at: Accessed: June 4, 2011.

Ooi WL, Budner NS, Cohen H, Madhavan S, Alderman MH. “Impact of Race on Treatment Response and Cardiovascular Disease Among Hypertensives.” Hypertension. 1989;14:227-234.

The Office of Minority Health. Diabetes and African Americans. Available at: Accessed: June 4, 2011.

The Office of Minority Health. Heart Disease and African Americans. Available at: Accessed: June 4, 2011.

The Office of Minority Health. Obesity and African Americans. Available at: Accessed: June 4, 2011.

The Office of Minority Health. Stroke and African Americans. Available at: Accessed: June 4, 2011.

Parra EJ, Kittles RA, Shriver MD. "Implications of Correlations Between Skin Color and Genetic Ancestry for Biomedical Research." Nature Genetics. Oct 26 2004;36(11):S54-S60.

Saller, Anthony, et al. “Stroke Prevention: Awareness of Risk Factors for Stroke Among African American Residents in the Mississippi Delta Region.” Journal of the National Medical Association. 2010; February. Vol. 102, No. 2. 84-94.

Schneider AT, Pancioli AM, Khoury JC. et al. "Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke." JAMA. 2003;289:343-346.

Young JH, Chang YP, Kim JD, et al. "Differential Susceptibility to Hypertension Is Due to Selection During the Out-of-Africa Expansion." PLoS Genetics. 2005;1:e82.

Publication Review By: the Editorial Staff at

Published: 19 Jun 2011

Last Modified: 06 Oct 2015