Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T21:25:27.643Z Has data issue: false hasContentIssue false

Stroke Risk Factors

Published online by Cambridge University Press:  07 November 2014

Abstract

Despite advances in the treatment of acute cerebral infarction, the most effective method of reducing stroke morbidity and mortality is the identification and modification of stroke risk factors. Modifiable stroke risk factors include hypertension, atrial fibrillation, hypercholesterolemia, cigarette smoking, hyperhomocystinemia, and carotid stenosis. Improved identification of individuals at increased stroke risk due to these factors can reduce individual risk and the cost to society of the consequences of stroke.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Broderick, J, Brott, T, Kothari, R, et al.The greater Cincinnati/Northern Kentucky Stroke Study. Stroke. 1998;29:415421.CrossRefGoogle ScholarPubMed
2.Garraway, WM, Whisnant, JP. The changing pattern of hypertension and the declining incidence of stroke. JAMA. 1987;258:214217.Google Scholar
3.Wolf, PA, D'Agostino, RB, O'Neal, MA, et al.Secular trends in stroke incidence and mortality: the Framingham Study. Stroke. 1992;23:15511555.Google Scholar
4.Brown, RD, Whisnant, JP, Sicks, RD, et al.Stroke incidence, prevalence and survival: secular trends in Rochester, Minnesota through 1989. Stroke. 1996;27:373380.Google Scholar
5.Gillum, RF. Stroke in blacks. Stroke. 1988;19:19.Google Scholar
6.Howard, G, Anderson, R, Sorlie, P, et al.Ethnic differences in stroke mortality between non-Hispanic whites, Hispanic whites, and blacks: the National Longitudinal Mortality Study. Stroke. 1994;25:21202125.CrossRefGoogle ScholarPubMed
7.Giles, WH, Kittner, SJ, Hebel, JR, et al.Determinants of black-white differences in the risk of cerebral infarction. Arch Intern Med. 1995;155:13191324.Google Scholar
8.Sacco, RL, Boden-Albala, B, Gan, R, et al.Stroke incidence among white, black and Hispanic residents of an urban community. Am J Epidemiol. 1998;147:259268.Google Scholar
9.Rosenwaike, I. Mortality among the Puerto Rican born in New York City. Social Science Quarterly. 1983;64:375385.Google Scholar
10.Joutel, A, Corpechot, C, Ducros, A, et al.Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. Nature. 1996;383:707710.CrossRefGoogle ScholarPubMed
11.Kannel, WB, Wolf, PA, Verter, J, McNamara, PM. Epidemiologic assessment of the role of blood pressure in stroke. The Framingham Study. JAMA. 1970;214:301310.CrossRefGoogle ScholarPubMed
12.Menotti, A, Jacobs, DR Jr, Blackburn, H, et al.Twenty-five-year prediction of stroke deaths in the Seven Countries Study: the role of blood pressure and its changes. Stroke. 1996;27:381387.CrossRefGoogle Scholar
13.Collins, R, MacMahon, S. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull. 1994;50:272298.Google Scholar
14.Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the Hypertension Detection and Follow-up Program. III. Reduction in stroke incidence among persons with high blood pressure. JAMA. 1982;247:633638.CrossRefGoogle Scholar
15.SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:32553264.Google Scholar
16.Fagard, RH, Staessen, JA. Treatment of isolated systolic hypertension in the elderly. The Syst-Eur trial. Clin Exp Hypertens. 1999;21:491497.Google Scholar
17.Wolf, PA, Abbott, RD, Kannel, WB. Atrial fibrillation as an independent risk factor for stroke in the Framingham Study. Stroke. 1991;22:983988.Google Scholar
18.Brand, FN, Abbott, RD, Kannel, WB, Wolf, PA. Characteristics and prognosis of lone atrial fibrillation. JAMA. 1985;254:34493453.CrossRefGoogle ScholarPubMed
19.Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized trials. Arch Intern Med. 1994;154:14491457.Google Scholar
20.Kannel, WB, Wolf, PA, Verter, J. Manifestations of coronary artery disease predisposing to stroke. The Framingham Study. JAMA. 1983;250:29422946.Google Scholar
21.Loh, E, Sutton, MS, Wun, CC, et al.Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med. 1997;336:251257.Google Scholar
22.Roberts, JK, Omarali, I, Ditullio, MR, et al.Valvular strands and cerebral ischemia. Effects of demographics and strand characteristics. Stroke. 1997;28:21852188.Google Scholar
23.Gilon, D, Buonanno, FS, Joffe, M, et al.Lack of evidence of an association between mitralvalve prolapse and stroke in young patients. N Engl J Med. 1999;341:813.CrossRefGoogle ScholarPubMed
24.Hausmann, D, Mugge, A, Daniel, WC. Identification of patent foramen ovale permitting paradoxical embolism. J Am Coll Cardiol. 1995;26:10301038.Google Scholar
25.DiTullio, MR, Sacco, RL, Gopal, A, et al.Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med. 1992;117:461465.Google Scholar
26.Amarenco, P, Duyckaerts, C, Tzourio, C. The prevalance of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med. 1992;326:222225.Google Scholar
27.Amarenco, P, Cohen, A, Tzourio, C. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994;331:14741479.Google Scholar
28.Horowitz, DR, Tuhrim, S, Budd, J, Goldman, ME. Aortic plaque in a series of patients with brain ischemia: diagnosis by transesophageal echocardiography. Neurology. 1992;42:16021604.Google Scholar
29.Horowitz, DR, Tuhrim, S, Weinberger, JM, Budd, J, Alweiss, CS, Goldman, ME. Transesophageal echocardiography: diagnostic and clinical applications in the evaluation of the stroke patient. Journal of Stroke and Cerebrovascular Diseases. 1997;6:332336.Google Scholar
30.Iso, H, Jacobs, DRJ, Wentworth, D, et al.Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the MRFIT. N Engl J Med. 1989;320:98049810.Google Scholar
31.Prospective Studies Collaboration. Cholesterol diastolic blood pressure and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet. 1995;346:16471653.CrossRefGoogle Scholar
32.Fried, LP, Borhani, NO, Enright, P, et al.The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1:263276.Google Scholar
33.Hebert, PR, Gaziano, JM, Chan, KS, Hennekens, CH. Cholesterol lowering with statin drugs, risk of stroke and total mortality: an overview of randomized trials. JAMA. 1997;278:313321.CrossRefGoogle ScholarPubMed
34.The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with mavastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:349357.Google Scholar
35.Furberg, CD. Natural statins and stroke risk. Circulation. 1999;99:185188.Google Scholar
36.Rubins, HB, Robins, SJ, Collins, D, et al.Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high density lipoprotein cholesterol. N Engl J Med. 1999;341:410418.Google Scholar
37.Wolf, PA, D'Agostino, RB, Kannel, WB, et al.Cigarette smoking as a risk factor for stroke. JAMA. 1998;259:10251029.Google Scholar
38.Kawacki, I, Colditz, GA, Stampfer, MJ, et al.Smoking cessation and decreased risk of stroke in women. JAMA. 1993;269:232236.CrossRefGoogle Scholar
39.Lindegaard, B, Hillbom M. Associations between brain infarction, diabetes and alcoholism: observations from the Gothenburg population cohort study. Acta Neurol Scand. 1987;75:195200.Google Scholar
40.Abbott, RD, Donahue, RP, MacMahon, SW, et al.Diabetes and the risk of stroke: the Honolulu Heart Program. JAMA. 1987;257:949956.Google Scholar
41.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703712.Google Scholar
42.Camargo, C. Moderate alcohol consumption and stroke. Stroke. 1989;20:16111626.Google Scholar
43.Sacco, RL, Elkind, M, Boden-Albala, B, et al.The protective effect of moderate alcohol consumption on ischemic stroke. JAMA. 1999;281:11121120.Google Scholar
44.The Antiphospholipid Antibodies in Stroke Study (APASS) Group. Anticardiolipin antibodies are an independent risk factor for first ischemic stroke. Neurology. 1993;43:20692073.Google Scholar
45.Muir, KW, Squire, IB, Alivan, W, Lees, KR. Anticardiolipin antibodies in an unselected stroke population. Lancet. 1994;344:452456.Google Scholar
46.Ginsburg, KS, Liang, MH, Newcomer, L, et al.Anticardiolipin antibodies and the risk for ischemic stroke and venous thrombosis. Ann Intern Med. 1992;117:9971002.Google Scholar
47.Tuhrim, S, Rand, JH, Wu, X, et al.Elevated anticardiolipin antibody titer is a stroke risk factor in a multiethnic population independent of isotype or degree of positivity. Stroke. 1999;30:15611565.Google Scholar
48.Tuhrim, S. Rand, JH, Wu, X, et al.Antiphosphatidylserine antibodies are independently associated with ischemic stroke. Neurology. 1999;53:15231527.Google Scholar
49.Toschi, V, Motta, A, Castelli, C, Paracchini, ML, Zerbi, D, Gibelli, A. High prevalence of antiphosphatidylinositol antibodies in young patients with cerebral ischemia of undetermined cause. Stroke. 1998;29:17591764.Google Scholar
50.Rand, JH. Antiphospholipid antibody syndrome: new insights on thrombogenetic mechanisms. Am J Med Sci. 1998;316:142151.Google Scholar
51.The WARSS, APASS, PICSS HAS, and GENESIS Study Groups. The feasibility of collaborative double-blind study using an anticoagulant. Cerebrovasc Dis. 1997;7:100122.Google Scholar
52.Giles, WH, Croft, JB, Greenlund, KJ, Ford, LS, Kittner, SJ. Total homocyst(e)ine concentration and the likelihood of nonfatal stroke: results from the Third National Health and Nutrition Examination Survey, 1988-1994. Stroke. 1998;29:24732477.Google Scholar
53.Perry, IJ, Refsum, H, Morris, RW, Ebrahim, SB, Ueland, PM, Shaper, AG. Prospective study of serum total homocysteine concentration and risk of stroke in middle-aged British men. Lancet. 1995;346:13951398.Google Scholar
54.Chimowitz, MI, Weiss, DG, Cohen, SL, et al.Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Stroke. 1994;25:759765.CrossRefGoogle ScholarPubMed
55.Roederer, GO, Langlois, YE, Jager, KA, et al.The natural history of carotid arterial disease in asymptomatic patients with cervical bruits. Stroke. 1984;15:605613.Google Scholar
56.Wilson, PWF, Hoeg, JM, D'Agostino, RB, et al.Cumulative effects of high cholesterol levels, high blood pressure, and cigarette smoking on carotid stenosis. N Engl J Med. 1997;337:516522.Google Scholar
57.Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:14211428.Google Scholar
58.European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-19%) carotid stenosis. Lancet. 1991;337:12351243.Google Scholar
59.North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445451.Google Scholar
60.Chassin, MR. Appropriate use of carotid endarterectomy. N Engl J Med. 1998;339:14681471.CrossRefGoogle ScholarPubMed
61.Barnett, HJM, Meldrum, HE, Eliasziw, M. The dilemma of surgical treatment for patients with asymptomatic disease. Ann Intern Med. 1995;123:723725.CrossRefGoogle Scholar
62.Wolf, PA, D'Agostino, RB, Belanger, AJ, Kannel, WB. Probability of stroke: a risk profile from The Framingham Study. Stroke. 1991;22:312318.Google Scholar
63.Gorelick, PB. Stroke prevention: an opportunity for efficient utilization of health resources during the coming decade. Stroke. 1994;25:220224.Google Scholar