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Newer risk factors for stroke
1Department of Neurology, Columbia University College of Physicians and Surgeons and the New York Presbyterian Hospital, New York, New York, USA.
Insights
Identifying stroke risk factors is key to reducing its global burden. This study highlights genetic predispositions and modifiable factors like physical activity and alcohol consumption, offering new insights for prevention.
Area of Science:
- Neurology
- Epidemiology
- Cardiovascular Research
Background:
- Stroke is a leading cause of disability and mortality worldwide.
- Understanding non-modifiable (age, ethnicity) and modifiable (hypertension, diabetes, smoking) risk factors is crucial for prevention.
- The Northern Manhattan Stroke Study offers new data on stroke risk.
Purpose of the Study:
- To investigate stroke risk factors in diverse populations.
- To clarify the roles of lipids, apolipoproteins, and novel factors in ischemic stroke.
- To identify modifiable factors for stroke risk reduction.
Main Methods:
- Analysis of data from the Northern Manhattan Stroke Study.
- Examination of incidence rates across different ethnic groups.
- Evaluation of lipid profiles, apolipoproteins, and other potential risk factors.
Main Results:
- African-Americans and Hispanics showed a higher stroke incidence compared to Caucasians.
- Physical activity and moderate alcohol consumption were confirmed as protective.
- High-density lipoprotein demonstrated a protective effect, while lipoprotein-a increased stroke risk.
- The apolipoprotein B/A-1 ratio correlated with carotid atheroma.
Conclusions:
- Stroke risk is influenced by ethnicity, with higher incidence in African-Americans and Hispanics.
- Modifiable factors like physical activity and moderate alcohol intake are vital for stroke prevention.
- Lipid profiles and novel factors like homocysteine and chronic infections require further investigation for stroke prediction.
Abstract:
Stroke places a tremendous burden on health resources throughout the world. Improved detection and modification of risk factors could reduce the impact of this disease. Important non-modifiable risk factors for ischemic stroke include age, gender, ethnicity, and heredity. Modifiable risk factors include hypertension, cardiovascular disease, diabetes, hyperlipidemia, asymptomatic carotid stenosis, cigarette smoking, and alcohol abuse. Data from the Northern Manhattan Stroke Study provide new insights into these stroke risk factors. In this study, African-Americans and Hispanics had a greater incidence of stroke, with almost a twofold increase compared with Caucasians. The protective effect of physical activity and moderate alcohol consumption was confirmed and further established as modifiable risk factors. The independent effects of lipids, apolipoproteins, and lipoprotein were also clarified. High-density lipoprotein was shown to be protective against ischemic stroke (particularly atherosclerotic stroke subtypes). Conversely, lipoprotein-a increased the risk for stroke. The ratio of apolipoprotein b to apolipoprotein a-1 was shown to be associated with carotid atheroma. In addition, newer risk factors, including homocysteine and chronic infection (Chlamydia pneumoniae and periodontal disease), are being studied as predictors of ischemic stroke. With these recent advances in the understanding of risk factors, the ability to detect or modify the risk for ischemic stroke should lead to a substantial reduction in the number of people killed or disabled by stroke each year.