Risk of stroke
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Understanding the Risk of Stroke: Key Factors and Prevention Strategies
Nonmodifiable Risk Factors for Stroke
Age, Sex, and Race/Ethnicity
Age is a significant nonmodifiable risk factor for stroke, with the risk increasing as individuals get older. Additionally, sex and race/ethnicity play crucial roles. Men are generally at higher risk than women, although women’s risk increases significantly after menopause. Certain racial and ethnic groups, such as African Americans and Hispanics, have higher stroke risks compared to Caucasians.
Modifiable Risk Factors for Stroke
Hypertension and Diabetes Mellitus
Hypertension is the most potent modifiable risk factor for stroke, significantly increasing the likelihood of both ischemic and hemorrhagic strokes. Diabetes mellitus also poses a substantial risk, often correlating with other conditions like atherosclerosis, which further elevates stroke risk .
Lifestyle Factors: Smoking, Diet, and Physical Inactivity
Behavioral factors such as smoking, poor diet, and physical inactivity are major contributors to stroke risk. Smoking doubles the risk of ischemic stroke, while a diet high in saturated fats and low in fruits and vegetables can lead to hypertension and obesity, both of which are stroke risk factors. Regular physical activity, on the other hand, is protective against stroke .
Prehypertension
Even prehypertension, defined as blood pressure levels between 120/80 mm Hg and 139/89 mm Hg, is associated with an increased risk of stroke. The risk is higher for those in the high-range prehypertension category.
Environmental and Occupational Factors
Environmental factors, including air pollution and lead exposure, have emerged as significant contributors to stroke risk. These factors are particularly impactful in low-income and middle-income countries, where exposure levels are often higher.
Genetic Factors
Genetic Polymorphisms and Single-Gene Disorders
Genetic factors also play a role in stroke risk. Single-gene disorders can lead to rare hereditary conditions where stroke is a primary manifestation. Additionally, common and rare genetic polymorphisms can influence the risk of more common stroke causes, such as atrial fibrillation.
Early Risk of Stroke After Transient Ischemic Attack (TIA)
Immediate Risk Post-TIA
The risk of stroke is significantly elevated immediately following a transient ischemic attack (TIA). Studies show that the risk of stroke within 7 days of a TIA can be as high as 5.2%, with the highest risks observed in population-based studies without urgent treatment.
Stroke Recurrence
Long-Term Risk of Recurrence
The risk of stroke recurrence is substantial, with a pooled cumulative risk of 3.1% at 30 days, 11.1% at 1 year, 26.4% at 5 years, and 39.2% at 10 years after the initial stroke. This highlights the importance of continuous secondary prevention strategies.
Global and Regional Variations
Lifetime Risk of Stroke
Globally, the lifetime risk of stroke from the age of 25 years onward is approximately 25%. However, this risk varies significantly by region, with the highest risks observed in East Asia, Central Europe, and Eastern Europe, and the lowest in eastern sub-Saharan Africa.
Conclusion
Stroke risk is influenced by a combination of nonmodifiable and modifiable factors. While age, sex, and race/ethnicity are beyond control, significant strides can be made in stroke prevention through lifestyle modifications, managing hypertension and diabetes, and reducing environmental exposures. Understanding these risk factors and implementing targeted prevention strategies can significantly reduce the global burden of stroke.
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