STROKE-RISK FACTORS, MODIFIABLE

SUMMARY

1. HTN: subjects with BP lower than 120/80 mmHg have half the life-time risk¹
- 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 risk⁴

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 2.96⁵

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

Ref: 1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

Reference(s)

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].