Strokes risk factors

Gerraty RP, Bowser DN, Infeld BC et al. (1996). Microemboli during carotid angiography association with stroke risk factors or subsequent magnetic resonance imaging changes Stroke 27 1543-1547 Gerriets T, Seidel G, Fiss IC et al. (1999). 

Reeves MJ, Hogan JG, Rafferty AP (2002). Knowledge of stroke risk factors and warning signs among Michigan adults. Neurology 59 1547-1552... 

Primary prevention strategies that address the risk factors for ischemic stroke can be powerful in reducing the costs of stroke. Many of the stroke risk factors can be modified and some eliminated at very low costs (lifestyle changes), therefore developing risk-factor-reduction strategies may be the most cost-effective measure of all. More research is needed in identifying the cost-effectiveness of other forms of acute stroke treatment. 

Atrial fibrillation with mitral valve disease has long been considered a stroke risk factor. Recurrent embolism occurs in 30-65% of patients with rheumatic mitral valve disease who have a history of a previous embolic event. Most of these recurrences (around 60%) develop within the first year. Mechanical prosthetic valves are a prime site for thrombus formation and patients with these valves require anticoagulation [7, 38]. Bacterial endocarditis can cause stroke as well as intracerebral mycotic aneurysms. Because mycotic aneurysms are inflammatory defects in the vessel wall, treatment with systemic thrombolysis or anticoagulation can lead to rupture with subsequent lobar hemorrhage. Nonbacterial, or marantic, endocarditis is also associated with multiple embolic strokes. This condition is most common in patients with mucinous carcinoma and may be associated with a low-grade disseminated intravascular coagulation. A nonbacterial endocarditis, called Libman-Sacks endocarditis, occurs in patients with systemic lupus erythematosus (SLE) [42],... 

Consider Hypercoagulable Panel in young patients without apparent stroke risk factors. 

Sipos, K., Bodo, M., Veer, A., Hagtvet, K.A., Banyasz, A., 1994. Neurosis, depression, anxiety and stroke risk factors in a Hungarian village. In Kalokagathia (Review of the Hung. Univ. of Physical Education) vol. XXXII, pp. 94-114, Budapest. 

The ROCKET-AF study [55] tested the efficacy and safety of rivaroxaban, a novel factor Xa inhibitor, in 14,264 patients with nonvalvular AF and additional stroke risk factors compared with standard warfarin therapy aiming at an international normalized ratio (INR) of 2.0-3.0. Rivaroxaban is predominantly metabolized by the liver, but approximately one third of the drug is cleared by the kidneys. The ROCKET-AF trial excluded patients with an eGFR <30 ml/ min, whereas the daily dose of rivaroxaban was reduced from 20 to 15 mg in patients with an eGFR of 30-49 ml/min based on available PD data and PK modelling [55]. 

Homocysteine arises from dietary methionine. High levels of homocysteiae (hyperhomocysteinemia) are a risk factor for occlusive vascular diseases including atherosclerosis and thrombosis (81—84). In a controlled study, semm folate concentrations of <9.2 nmol/L were linked with elevated levels of plasma homocysteiae. Elevated homocysteine levels have beea associated also with ischemic stroke (9). The mechanism by which high levels of homocysteine produce vascular damage are, as of yet, aot completely uaderstood. lateractioa of homocysteiae with platelets or eadothehal cells has beea proposed as a possible mechanism. Clinically, homocysteine levels can be lowered by administration of vitamin B, vitamin B 2> foHc acid. 

Hypertension is one of the two principal risk factors of many cardiovascular diseases, such as coronary heart disease (CHD), stroke, and CHF. Individuals are considered hypertensive if their systoHc arterial blood pressure is over 140 mm Hg (18.7 Pa) or their diastoHc arterial blood pressure is over 90 mm Hg (12 Pa). Over 60 million people, or one-third of the adult population in the United States are estimated to be hypertensive (163). About 90% of these patients are classified as primary or essential hypertensive because the etiology of their hypertension is unknown. It is generally agreed that there is a very strong genetic or hereditary component to this disease. 

Larrue V, von Kummer RR, Muller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator A secondary analysis of the european-australasian acute stroke study (ECASS II). Stroke. 2001 32 438 1. 

Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994 154 1449-1457. 

Epidemiological data on carotenoids and cerebral infarcts or strokes indicate a protective effect of P-carotene and lycopene. Indeed, the Basel prospective study, the Kuopio Ischaemic Heart Disease Risk Factor study, and the Physicians Health Study " have shown an inverse correlation between carotenoid plasma level and risk of stroke. In the same way, Hirvonen et al. demonstrated, in findings from the ATBC cancer prevention stndy, an inverse association between P-carotene dietary intake and stroke. However, clinical data on carotenoids and stroke are nonexistent and they are needed to confirm this possible protective effect of carotenoids on stroke. 

Rissanen, T.H. et al.. Low serum lycopene concentration is associated with an excess incidence of acute coronary events and stroke the Kuopio Ischaemic Heart Disease Risk Factor Study, Br. J. Nutr., 85, 749, 2001. 

Risk factors for embolic cerebrovascular accidents include previous ischemic stroke, transient ischemic attacks (TIA), systemic embolism, age >75 yr, moderately or severely impaired left ventricular systolic function, hypertension, diabetes mellitus... 

Recent data suggest that COX-2 inhibitors, including rofe-coxib, valdecoxib, and celecoxib, may increase the risk for MI and stroke.47 There is also some evidence that the non-selective NSAIDs may increase the risk for cardiovascular events.47,48 Rofecoxib was withdrawn from the market in late 2004 because of safety concerns. The FDA requested the withdrawal of valdecoxib from the market in 2005. The FDA also asked the manufacturers of celecoxib and non-selective NSAIDs (prescription and over-the-counter) to include information about the potential adverse cardiovascular effects of these drugs in their product labeling. The cardiovascular risk with COX-2 inhibitors and NSAIDs may be greatest in patients with a history of, or with risk factors for, cardiovascular disease. The American Heart Association recommends that the use of COX-2 inhibitors be limited to low-dose, short-term therapy in patients for whom there is no appropriate alternative.48 Patients with cardiovascular disease should consult a clinician before using over-the-counter NSAIDs. 

The majority of patients with AF should receive warfarin therapy (titrated to an International Normalized Ratio of 2 to 3) for stroke prevention, particularly if they have other risk factors for stroke. 

Stroke Prevention All patients with paroxysmal, persistent, or permanent AF should receive therapy for stroke prevention, unless compelling contraindications exist. A decision strategy for stroke prevention in AF is presented in Fig. 6-9.27 In general, most patients require therapy with warfarin in some patients with no additional risk factors for stroke, aspirin may be acceptable. For some patients, serious consideration of the benefits of warfarin versus the risks of bleeding associated with warfarin therapy is warranted. The potential bleeding risks associated with warfarin may outweigh the benefits in... 

FIGURE 6-9. Decision algorithm for stroke prevention in atrial fibrillation.27 Risk factors for stroke prior transient ischemic attack or stroke hypertension heart failure rheumatic heart valve disease prosthetic heart valve. Target International Normalized Ratio = 2.5 (range 2 to 3). 

Moderate Major or minor surgery, age 40-60 years, and no clinical risk factors Major surgery, age less than 40 years, and no clinical risk factors Minor surgery, with clinical risk factor(s) Acutely ill (e.g., myocardial infarction, ischemic stroke, heart failure exacerbation), and no clinical risk factors 10-20 1-2 I o UFH 5000 units SC every 12 hours Dalteparin 2500 units SC every 24 hours Enoxaparin 40 mg SC every 24 hours Tinzaparin 3500 units SC every 24 hours IPC Graduated compression stockings... 

Identify the modifiable and non-modifiable risk factors associated with ischemic stroke and hemorrhagic stroke. 

Identify risk factors for ischemic stroke in a patient and provide the appropriate patient education. 

A major goal in the long-term treatment of ischemic stroke involves the prevention of a recurrent stroke through the reduction and modification of risk factors. 

Assessment of risk factors for ischemic stroke as well as for hemorrhagic stroke is an important component of the diagnosis and treatment of patients. A major goal in the long-term treatment of ischemic stroke involves the prevention of a recurrent stroke through the reduction and modification of risk factors. The major focus of primary prevention (prevention of the first stroke) is also reduction and modification of risk factors. Risk factors for ischemic stroke can be divided into modifiable and non-modifiable factors. Every patient should have risk factors assessed and treated, if possible, as management of risk factors can decrease the occurrence and/or recurrence of stroke.4... 

Non-modifiable risk factors include age, gender, race/ ethnicity, and heredity. Ischemic stroke risk is increased in those greater than 55 years of age, in men, and in African-Americans, Hispanics, and Asian-Pacific Islanders. It is also increased in those with a family history of stroke. Modifiable risk factors include a number of treatable disease states and lifestyle factors that can greatly influence overall stroke risk. Hypertension is... 

TABLE 8-2. Non-modifiable Risk Factors for Ischemic Stroke... 

Tests for hypercoagulable states, such as protein C deficiency and antiphospholipid antibody, should be done only when the cause of stroke cannot be determined based on the presence of well-known risk factors for stroke. 

The electrocardiogram will determine whether the patient has atrial fibrillation, which is a major risk factor for stroke. 

What non-modifiable and modifiable risk factors does GR have for acute ischemic stroke ... 

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