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STROKE-MODIFIABLE RISK FACTORS

Neurology

STROKE-MODIFIABLE RISK FACTORS

1. HTN: subjects with BP lower than 120/80 mmHg have half the life-time risk (Seshadri et al.,1997).

2. TIA/prior stroke: 5% of patients with TIA will develop a stroke within 1 mth, 3%-17.3% within 3 mth (highest within the first 1 mth) & 14% within 1 yr (Coull et al., 2004; Johnston et al., 2003).

3. Heart disease: CHF & CAD increase risk by 2x. Valvular heart disease and arrhythmias increase risk of embolic stroke.

4. AF: 5x increased risk (Wolf et al., 1991).

5. DM: 2x risk, good blood sugar control has not been shown to alter the risk.

6. Cigarette smoking: risk of ischemic stroke in smokers is ~2x that of non-smokers.

7. Carotid stenosis: endarterectomy is of benefit to prevent stroke in patients with > 70% stenosis (absolute risk reduction 16.0%).

8. High-dose estrogens (OCP use): considerable increased risk when linked with cigarette smoking.

9. ETOH abuse/cocaine use: < 2 drinks/day relative risk 0.51; > 7 drinks/day relative risk 2.96 (Sacco et al., 1999).

10. Hypercoagulable states: protein C & S deficiency, malignancy, polycythemia, sickle cell anemia.

11. Hyperlipidemia: reduction in risk with use of cholesterol reducing agents (30% risk reduction with HMG-CoA reductase inhibitors).

12. Migraine headaches.

13. Sleep apnea.

14. Patent foramen ovale (PFO).


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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