Difference between revisions of "STROKE-RISK FACTORS, MODIFIABLE"
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===== [[Summary Article|'''SUMMARY''']] ===== | ===== [[Summary Article|'''SUMMARY''']] ===== | ||
1. HTN: subjects with BP lower than 120/80 mmHg have half the life-time risk< | 1. HTN: subjects with BP lower than 120/80 mmHg have half the life-time risk<ref>Seshadri, S., Beiser, A., Kelly-Hayes, M., Kase, C.S., Au, R., Kannel, W.B. and Wolf, P.A., 2006. The lifetime risk of stroke: estimates from the Framingham Study. <i>Stroke,</i> 37(2), pp.345-350.</ref> | ||
<br/>- Target recommendations from Australian Stroke Foundation Clinical Guidelines 2012 (target BP ≤ 140/90mmHg for patients without CVD; ≤ 130/80 for patients with micro/macroalbuminuria; ≤ 130/80mmHg for patients with diabetes) | <br/>- Target recommendations from Australian Stroke Foundation Clinical Guidelines 2012 (target BP ≤ 140/90mmHg for patients without CVD; ≤ 130/80 for patients with micro/macroalbuminuria; ≤ 130/80mmHg for patients with diabetes) | ||
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<br/>2. TIA/prior stroke: 5% of patients with TIA will develop a stroke within 1 mth, 3%-17.3% within 3 mth (highest within the first 1 mth) & 14% within 1 yr< | <br/>2. TIA/prior stroke: 5% of patients with TIA will develop a stroke within 1 mth, 3%-17.3% within 3 mth (highest within the first 1 mth) & 14% within 1 yr<ref>Coull, A., Lovett, J.K. and Rothwell, P.M., 2004. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. <i>Bmj,</i> 328(7435), p.326.</ref><ref>Johnston, S.C., Sidney, S., Bernstein, A.L. and Gress, D.R., 2003. A comparison of risk factors for recurrent TIA and stroke in patients diagnosed with TIA. <i>Neurology,</i> 60(2), pp.280-285.</ref> | ||
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<br/>3. Heart disease: CHF & CAD increase risk by 2x, valvular heart disease and arrhythmias increase risk of embolic stroke | <br/>3. Heart disease: CHF & CAD increase risk by 2x, valvular heart disease and arrhythmias increase risk of embolic stroke | ||
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<br/>4. AF: 5x increased risk< | <br/>4. AF: 5x increased risk<ref>Wolf, P.A., Abbott, R.D. and Kannel, W.B., 1991. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. <i>Stroke,</i> 22(8), pp.983-988.</ref> | ||
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<br/>5. DM: 2x risk, good blood sugar control has not been shown to alter the risk | <br/>5. DM: 2x risk, good blood sugar control has not been shown to alter the risk | ||
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<br/>8. High-dose estrogens (OCP use): considerable increased risk when linked with cigarette smoking | <br/>8. High-dose estrogens (OCP use): considerable increased risk when linked with cigarette smoking | ||
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<br/>9. ETOH abuse/cocaine use: < 2 drinks/day relative risk 0.51; > 7 drinks/day relative risk 2.96< | <br/>9. ETOH abuse/cocaine use: < 2 drinks/day relative risk 0.51; > 7 drinks/day relative risk 2.96<ref>Sacco, R.L., Elkind, M., Boden-Albala, B., Lin, I.F., Kargman, D.E., Hauser, W.A., Shea, S. and Paik, M.C., 1999. The protective effect of moderate alcohol consumption on ischemic stroke. <i>Jama,</i> 281(1), pp.53-60.</ref> | ||
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<br/>10. Hypercoagulable states: protein C & S deficiency, malignancy, polycythemia, sickle cell anemia | <br/>10. Hypercoagulable states: protein C & S deficiency, malignancy, polycythemia, sickle cell anemia | ||
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<br/>15. Diet, lifestyle, obesity reduction | <br/>15. Diet, lifestyle, obesity reduction | ||
==Reference(s)== | ==Reference(s)== | ||
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.] | <references /> | ||
<br/>Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.] | |||
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.] | <br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.] | ||
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy. | <br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy. | ||
Latest revision as of 11:31, 21 February 2023
SUMMARY
1. HTN: subjects with BP lower than 120/80 mmHg have half the life-time risk[1]
- Target recommendations from Australian Stroke Foundation Clinical Guidelines 2012 (target BP ≤ 140/90mmHg for patients without CVD; ≤ 130/80 for patients with micro/macroalbuminuria; ≤ 130/80mmHg for patients with diabetes)
2. TIA/prior stroke: 5% of patients with TIA will develop a stroke within 1 mth, 3%-17.3% within 3 mth (highest within the first 1 mth) & 14% within 1 yr[2][3]
3. Heart disease: CHF & CAD increase risk by 2x, valvular heart disease and arrhythmias increase risk of embolic stroke
4. AF: 5x increased risk[4]
5. DM: 2x risk, good blood sugar control has not been shown to alter the risk
6. Cigarette smoking: risk of ischemic stroke in smokers is ~2x that of non-smokers
7. Carotid stenosis: endarterectomy is of benefit to prevent stroke in patients with > 69% stenosis (absolute risk reduction 16.0%)
8. High-dose estrogens (OCP use): considerable increased risk when linked with cigarette smoking
9. ETOH abuse/cocaine use: < 2 drinks/day relative risk 0.51; > 7 drinks/day relative risk 2.96[5]
10. Hypercoagulable states: protein C & S deficiency, malignancy, polycythemia, sickle cell anemia
11. Hyperlipidemia: reduction in risk with use of cholesterol reducing agents (30% risk reduction with HMG-CoA reductase inhibitors)
- Target recommendations from Australian Stroke Foundation Clinical Guidelines 2012 (Total Cholesterol < 4mmol/L; HDL-C ≥ 1.0mmol/L; LDL-C < 2.0mmol/L; TG < 2.0mmol/L; Non-HDL-C < 2.5mmol/L)
12. Migraine headaches
13. Sleep apnea
14. Patent foramen ovale (PFO)
15. Diet, lifestyle, obesity reduction
Reference(s)
- ↑ Seshadri, S., Beiser, A., Kelly-Hayes, M., Kase, C.S., Au, R., Kannel, W.B. and Wolf, P.A., 2006. The lifetime risk of stroke: estimates from the Framingham Study. Stroke, 37(2), pp.345-350.
- ↑ Coull, A., Lovett, J.K. and Rothwell, P.M., 2004. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. Bmj, 328(7435), p.326.
- ↑ Johnston, S.C., Sidney, S., Bernstein, A.L. and Gress, D.R., 2003. A comparison of risk factors for recurrent TIA and stroke in patients diagnosed with TIA. Neurology, 60(2), pp.280-285.
- ↑ Wolf, P.A., Abbott, R.D. and Kannel, W.B., 1991. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke, 22(8), pp.983-988.
- ↑ Sacco, R.L., Elkind, M., Boden-Albala, B., Lin, I.F., Kargman, D.E., Hauser, W.A., Shea, S. and Paik, M.C., 1999. The protective effect of moderate alcohol consumption on ischemic stroke. Jama, 281(1), pp.53-60.
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
