Risk Factors

Stroke risk factors may be modifiable or not. Age, sex, and genetic predisposition are non-modifiable risk factors (also known as risk markers)[1]. Age is the most significant; after 55 years of age the risk for stroke doubles for every decade[2].

Main modifiable risk factors for ischemic stroke are the following:

1
Arterial hypertension

this is the most important stroke risk factor and accounts for half ischemic strokes[3]. Apart from antihypertensive medical treatment, it is important to change the way of life to reduce cardiovascular risk[4].

2
Diabetes mellitus

even prediabetes is correlated with ischemic stroke risk. The duration of diabetes is also relevant[5]. Paradoxically, strict glycemic control has not proven effective in reducing risk by itself and a healthy way of life is important[6].

3
Atrial fibrillation

this cardiac arrhythmia seems to make part of a complex cardiac condition called atrial myocardiopathy that may lead through diverse mechanisms to cardioembolic stroke[7]. Permanent atrial fibrillation is easy to diagnose through an ECG but paroxysmal poses a major diagnostic challenge as ECG monitoring during hospitalization may fail to capture a paroxysm since the patient may retain sinus rhythm for long periods of time. These patients are at risk of remaining undiagnosed and therefore pursue an antiplatelet drug that only modestly reduces cardioembolic risk, in contrast to anticoagulation which is highly effective for preventing embolism in patients with atrial fibrillation46. 4. Dyslipidemia: the relationship between dyslipidemia and stroke is complex and not fully elucidated; however, it seems that statin treatment is safe for hemorrhagic strokes and effective for reducing ischemic stroke risk[8].

4
Dyslipidemia

the relationship between dyslipidemia and stroke is complex and not fully elucidated; however, it seems that statin treatment is safe for hemorrhagic strokes and effective for reducing ischemic stroke risk[9].

5
Sedentary life, unhealthy diet

lack of exercise is associated with many negative consequences to human health and well-being, including strokes. The deleterious effects may be mediated through metabolic syndrome and obesity[10].

6
Smoking

around 15% of stroke deaths are attributed to smoking[11]. Smoking cessation leads to rapid risk normalization within 2-years[12].

REFERENCES

[1] Boehme AK, et al. Circ Res. 2017;120(3):472-495.

[2] Roger VL, et al. Circulation. 2012; 125:188–197.

[3] O’Donnell MJ, et al. Lancet. 2010; 376:112–123.

[4] Chobanian AV, et al. JAMA. 2003; 289:2560–2572.

[5] Banerjee C, et al. Stroke. 2012; 43:1212–1217.

[6] Holman RR, et al. N Engl J Med. 2008; 359:1577–1589.

[7] Kamel H, et al. Stroke. 2016; 47:895–900.

[8] Aguilar MI, et al. Database Syst Rev. 2007;(3):CD006186.

[9] Baigent C, et al. Lancet. 2005; 366:1267–1278.

[10] Arenillas JF, et al. Stroke. 2007; 38:2196–2203.

[11] Thun MJ, et al. JAMA. 2000; 284:706–712.

[12] Song YM, et al. Stroke. 2008; 39:2432–2438.