Definition and Overview
Stroke risk factors are biological, environmental, and behavioral factors that statistically significantly increase the likelihood of stroke. Risk factors are divided into non-modifiable factors and modifiable factors, and active management of the latter is the key to primary prevention of stroke.
The INTERSTROKE study (O'Donnell et al., 2010) analyzed more than 6,000 stroke patients in 22 countries and confirmed that 10 modifiable risk factors (hypertension, smoking, abdominal obesity, diet, physical inactivity, diabetes, excessive drinking, psychogenic causes, apolipoprotein ratio, psychosocial stress) accounted for approximately 90% of the population-attributable risk of all strokes.
Non-correctable risk factors
Age is the strongest risk factor, with the risk of stroke approximately doubling every 10 years after age 55 and rising sharply above age 75.
Among genders, men have a slightly higher risk overall, but women have a unique risk pattern in pregnancy, oral contraceptive use, migraine, and stroke due to atrial fibrillation.
In terms of genetics and family history, the risk increases if a first-degree relative has a history of early stroke (under 55 years of age for men and 65 years of age for women). Single gene diseases such as hereditary thrombosis and CADASIL also exist.
Some races, such as blacks and Hispanics, have higher stroke incidence and mortality rates.
Correctable risk factors
Hypertension is the single greatest risk factor for stroke, with a population attributable risk of 35-50%. There is a meta-analysis showing that lowering blood pressure reduces the risk of stroke by about 38%.
Atrial fibrillation is a strong risk factor that increases the risk of stroke by approximately five times. Anticoagulant treatment (DOAC or warfarin) reduces the risk of cardioembolic cerebral infarction by approximately 60-70%.
Smoking increases the risk of ischemic stroke by approximately 1.5 to 2 times, and quitting smoking reduces the risk to near normal within a few years.
Diabetes mellitus approximately doubles the risk of stroke through small blood vessel lesions and acceleration of atherosclerosis, and blood sugar control contributes to stroke prevention.
In dyslipidemia, elevated LDL cholesterol promotes atherosclerosis, and statin treatment significantly reduces the risk of stroke.
Obesity and physical inactivity are also independent risk factors. Body mass index (BMI) over 30, abdominal obesity, and physical inactivity increase the risk of stroke through metabolic syndrome and various risk factors.
Other risk factors include sleep apnea, chronic renal failure, psychosocial stress, excessive drinking, diet (excessive salt, saturated fat), and drug abuse such as cocaine.
Risk Assessment
Stroke risk can be assessed using the composite risk factor scoring tool. Framingham stroke risk score, SCORE, CHA₂DS₂-VASc (only for atrial fibrillation patients), etc. are used clinically.
Intima-media thickness (IMT) measurement using carotid ultrasound can be used as an early indicator of subclinical atherosclerosis.
prevention strategies
The key to primary prevention (patients who have not had a stroke) is active management of correctable risk factors.
For blood pressure management, a goal of less than 130/80 mmHg is generally recommended. Lifestyle improvement (low-salt diet, exercise, weight loss) and drug treatment are combined.
These include early detection of atrial fibrillation, anticoagulant treatment, diabetes control (HbA1c target less than 7%), statin treatment for dyslipidemia, smoking cessation, moderate-intensity exercise for more than 150 minutes a week, and Mediterranean diet.
In patients with multiple risk factors, an integrated management approach is more effective than managing risk factors individually.
prognosis
Stroke is a disease that is largely preventable through risk factor management. Epidemiological data confirms that improvements in blood pressure, smoking, and diabetes management at the population level have contributed to reducing the incidence of stroke. However, the absolute number of patients continues to increase due to aging and an increase in the diabetes and obesity population, making the importance of active risk factor management even greater.
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This information is provided for medical educational purposes and is not a substitute for individual medical care or treatment. If you have any symptoms, be sure to seek professional advice. Inquiries: Osang Neurosurgery 1599-5453 | osns.co.kr