Ischemic stroke risk factors
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2] Khizer Yaseen, M.B.B.S.[3]
Overview
Risk factors for stroke are divided into modifiable and non-modifiable risk factors. Modifiable risk factors include hypertension, diabetes mellitus, cardiac disease, cigarette smoking, alcohol consumption, hyperhomocysteinemia, hyperlipidemia, obesity, sedentary life style and oral contraceptive usage. Some of the non-modifiable risk factors include advanced age, male gender, family history of ischemic stroke, African-American and Hispanic race, and genetic diseases such as sickle cell disease.
Risk factor
Identification of risk factors for stroke is complicated by the fact that strokes come in many varieties. Risk factors for hemorrhagic and ischemic stroke are similar, but there are some notable differences; there are also differences in risk factors among the etiologic categories of ischemic stroke.[1][2] According to Framingham cohort and later research, the risk factors for ischemic stroke are as follows:
- Modifiable risk factors
- Hypertension
- cigarette smoking
- diet
- Physical Inactivity
- Hyperlipidemia
- Diabetes
- Alcohol Consumption
- Cardiac disease (Atrial fibrillation, Coronary artery disease)
- Apolipoprotein B to A1
- Hyperhomocysteinemia
- Hyperlipidemia
- Oral contraceptive usage
- Non-modifiable risk factors
- Age
- Sex
- Race/Ethnicity
- Sickle cell disease
There is a similar classification for the risk factors of hemorrhagic stroke, which is:
- Modifiable risk factors
- Hypertension
- Alcohol Consumption
- Diet
- Non-modifiable risk factors
- Age
- Sex
- Race/Ethnicity
Clinical features associated with PFO-related ischemic stroke include younger age, absence of vascular risk factors, and embolic cortical infarction patterns.[3]
Risk Stratification
The Risk of Paradoxical Embolism (RoPE) score is used to estimate the probability that a detected patent foramen ovale is causally related to ischemic stroke.[4]The PFO-Associated Stroke Causal Likelihood (PASCAL) classification integrates anatomical and clinical features to guide management decisions.[5]
References
- ↑ Boehme AK, Esenwa C, Elkind MS (February 2017). “Stroke Risk Factors, Genetics, and Prevention”. Circ Res. 120 (3): 472–495. doi:10.1161/CIRCRESAHA.116.308398. PMC 5321635. PMID 28154098.
- ↑ O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, Rangarajan S, Islam S, Pais P, McQueen MJ, Mondo C, Damasceno A, Lopez-Jaramillo P, Hankey GJ, Dans AL, Yusoff K, Truelsen T, Diener HC, Sacco RL, Ryglewicz D, Czlonkowska A, Weimar C, Wang X, Yusuf S (July 2010). “Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study”. Lancet. 376 (9735): 112–23. doi:10.1016/S0140-6736(10)60834-3. PMID 20561675.
- ↑ Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS, Griffith J, Jaigobin C, Mattle HP, Michel P, Mono ML, Nedeltchev K, Papetti F, Thaler DE. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013 Aug 13;81(7):619-25. doi: 10.1212/WNL.0b013e3182a08d59. Epub 2013 Jul 17. PMID: 23864310; PMCID: PMC3775694.
- ↑ Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS, Griffith J, Jaigobin C, Mattle HP, Michel P, Mono ML, Nedeltchev K, Papetti F, Thaler DE. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013 Aug 13;81(7):619-25. doi: 10.1212/WNL.0b013e3182a08d59. Epub 2013 Jul 17. PMID: 23864310; PMCID: PMC3775694.
- ↑ Saver JL, Mattle HP, Thaler D. Patent Foramen Ovale Closure Versus Medical Therapy for Cryptogenic Ischemic Stroke: A Topical Review. Stroke. 2018 Jun;49(6):1541-1548. doi: 10.1161/STROKEAHA.117.018153. Epub 2018 May 14. PMID: 29760277.
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