Stroke Research

• The Systolic Blood Pressure Intervention Trial (SPRINT) Study was a groundbreaking research study that looked at how treating to a lower systolic blood pressure target — less than 120 millimeters of mercury (mm Hg) — affects the cardiovascular system, kidneys, and brain. When it became clear that treating to the lower target of less than 120 mm Hg reduced cardiovascular events and saved lives in all participants, SPRINT ended early and its findings were shared. These results helped to inform new comprehensive high blood pressure guidelines released in 2017 by the American College of Cardiology and the American Heart Association. Findings from the SPRINT study also emphasize lifestyle changes as a way for many people to reach the lower blood pressure target and blood pressure medicines for some with high blood pressure.
• The NHLBI’s landmark Framingham Heart Study (FHS), launched in 1948, has contributed transformative discoveries for heart and blood vessel diseases such as stroke. These discoveries include the identification of high blood pressure and atrial fibrillation as risk factors for stroke. Through the FHS, scientists learned that many of those risk factors can be changed. Such findings are paving the way for new interventions to prevent, diagnose, or treat these conditions more effectively. The data also helped researchers develop a risk calculator to estimate the risk of stroke andr other conditions.

Our Division of Cardiovascular Sciences supports research aimed at preventing and treating stroke as well as other pediatric and adult cardiovascular diseases, including heart attack, heart failure, and congenital heart disease. The Division also supports the development of innovative technologies to diagnose, prevent, and treat cardiovascular disease.

The NHLBI also participates in a global partnership to advance research efforts in heart, stroke, and circulatory diseases. The partnership, called the Global Cardiovascular Research Funders Forum, works to identify research gaps and coordinate multinational clinical trials.

Current research on stroke prevention and treatment

• NHLBI-funded researchers are testing a new tool that makes it easier to navigate challenging vascular anatomy and reduce the time required to remove a blood clot. Most often, strokes are caused by blood clots that become lodged in a blood vessel in the brain, reducing or cutting off blood flow. Recent advances in device technology have made it possible for physicians to physically remove these clots, allowing blood flow to resume. However, this procedure is unsuccessful up to 30% of the time, owing to the difficulty of threading a catheter to the target artery and the amount of time required. This new tool could potentially improve patient outcomes.  
• NHLBI-funded researchers are conducting research to provide basic knowledge about the interactions between activated protein C and other proteins in the body. Activated protein C has shown beneficial effects for a number of disorders, including ischemic stroke. Researchers hope that understanding more about how it interacts with other proteins will one day produce new treatments for stroke and other conditions.
• NHLBI-funded researchers are developing and testing a new, reversible anticlotting treatment composed of a small RNA molecule that binds to and inhibits a specific clotting factor and another molecule that reverses this binding. Although the only drug currently approved to treat ischemic stroke — recombinant tissue plasminogen activator (rTPA) — reduces morbidity and mortality, it is also associated with risk of additional hemorrhage and other complications. Because of these potential complications, rTPA is given to less than 5% of stroke patients. The results of this study will provide safety screening and preclinical data with the ultimate aim of getting Food and Drug Administration approval for clinical trials.

Find more NHLBI-funded studies on stroke prevention and treatment at the NIH RePORTER. 

Current research on health disparities

• NHLBI-funded researchers are monitoring atrial fibrillation (Afib) among participants in the Jackson Heart Study (JHS), a large cohort study of the causes of cardiovascular disease in African Americans. Afib is a common type of arrhythmia (irregular heartbeat) that often causes no symptoms but can result in devastating complications, including stroke. Among African Americans, little is known about the true population burden of atrial fibrillation and of a related arrhythmia, supraventricular ectopy. The JHS results will inform prevention and treatment strategies to reduce the burden of Afib and its related complications among African Americans.
• In 2006, the NHLBI initiated the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest epidemiological study of diverse Hispanics/Latinos in the United States. This landmark study has enrolled 16,415 Hispanic/Latino adults living in San Diego, Chicago, Miami, and, in New York City’s the Bronx who self-identified as being of Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American origin. The study, which extends to 2024, focuses on the high prevalence of specific cardiovascular and pulmonary risk factors and diseases, differences in prevalence of these risk factors and diseases across heritage groups, and relationships between risk (or protective) factors and disease onset, morbidity, and mortality among Hispanics/Latinos.
• The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study aims to determine the causes for the excess stroke mortality in the southeastern United States and among African Americans. Launched in 2003, REGARDS has enrolled 30,000 African-American and white adults age 45 and older. The study has produced more than 600 publications on racial disparities in coronary heart disease and has identified new coronary heart disease risk factors.

Find more NHLBI-funded studies on health disparities and stroke at the NIH RePORTER. 

News release

Even after years of smoking, African Americans — who as a group are twice as likely as whites to have a stroke and die from it — could significantly reduce their risk if they quit. Learn more: NIH study links cigarette smoking to higher stroke risk in African Americans

Stroke monitoring and detection

• A team of NHLBI-supported researchers is working with stroke patients and their caregivers to develop and test a new smartwatch-based detection platform for atrial fibrillation (Afib). Afib is the world’s most common serious heart rhythm problem and causes 15% of all strokes. Long-term monitoring for early detection is recommended for many stroke patients, but existing cardiac monitors have limitations that make it difficult to use them long term.
• NHLBI-funded researchers are investigating whether some strokes are in fact the result of unrecognized plaque in the arteries leading to the brain. Currently, only those plaques that cause significant narrowing of the arteries are treated as an underlying cause for stroke. Yet emerging studies show that even plaques that do not significantly narrow arteries may rupture and produce clots that travel via the bloodstream to the brain. This research may point to a novel stroke risk factor and establish the scientific premise for improved risk factor screening and stroke prevention efforts.

Find more NHLBI-funded studies on stroke monitoring and detection at the NIH RePORTER.

The Division of Intramural Research, which includes investigators from the Population Sciences Branch, performs research on stroke and related disorders.

• Our Trans-Omics for Precision Medicine (TOPMed) Program studies how genetic information, along with information about health status, lifestyle, and the environment, can be used to predict the best ways to prevent and treat heart, lung, blood, and sleep disorders, including stroke. TOPMed specifically supports NHLBI’s Precision Medicine Activities.
• Since 1988, the Cardiovascular Health Study (CHS) has aimed to identify risk factors related to the onset of coronary heart disease and stroke in adults age 65 or older. A key CHS finding is that as we age, a large amount of plaque buildup and thickening occurs in the carotid arteries, and these changes may not cause symptoms. The presence of this plaque, known as atherosclerosis, predicts a higher risk of a stroke or heart attack. This was a landmark finding, demonstrating the importance of identifying the earliest stages of a cardiovascular disease process.
• The Multi-Ethnic Study of Atherosclerosis (MESA), which spanned 2 decades in six U.S. communities and recruited participants from diverse backgrounds, has helped us learn about the causes and results of plaque buildup. For example, NHLBI researchers using MESA data found a link between early menopause and risk of stroke. Women in the study who experienced menopause before age 46 were twice as likely to have a stroke as women who did not have early menopause. Although the study began in 1999, NHLBI’s TOPMed program is using MESA data today to explore how genetic information, along with information about health status, lifestyle, and the environment, can be used to predict the best ways to prevent and treat heart, lung, blood, and sleep disorders, including stroke.
• The Women’s Health Initiative (WHI) is one of the largest women’s health projects ever launched in the United States, having enrolled more than 161,000 women at 40 clinical centers since its launch in 1991. A key WHI finding is that the use of estrogen plus progestin hormone therapy after menopause increases a woman’s risk for heart disease, stroke, blood clots, breast cancer, and dementia. Because of these findings, we now know that hormone therapy — estrogen plus progestin or estrogen alone — should not be used in postmenopausal women to prevent heart disease or to lower cholesterol levels.