Risk factors for cryptogenic ischaemic stroke
V Karttunen1, G Alfthan, L Hiltunen
1Department of Neurology, Oulu University Central Hospital, Helsinki, Finland. vesa.karttunen@oulu.fi
Insights
Identifying risk factors for cryptogenic brain infarction is crucial. Hypertension, smoking, low HDL cholesterol, and high factor VIII activity are key contributors, with variations observed between men and women.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Genetics
Background:
- Cryptogenic brain infarction, stroke of unknown origin, affects individuals aged 15-60.
- Prothrombotic states, lipid profiles, and apolipoprotein E phenotypes are potential contributors.
- Understanding risk factors is vital for targeted prevention strategies.
Purpose of the Study:
- To identify modifiable and non-modifiable risk factors for cryptogenic brain infarction in a specific age group.
- To compare the frequency of these risk factors between patients and controls.
- To investigate potential differences in risk factors between genders.
Main Methods:
- A case-control study design was employed.
- 46 patients with cryptogenic brain infarction and 104 controls were analyzed.
- Logistic regression analysis was used to calculate multivariate odds ratios (ORs) for various risk factors, including homocysteine, lipoprotein (a) [Lp(a)], lipids, apolipoprotein E, and conventional risk factors.
Main Results:
- Hypertension (OR 4.5), current smoking (OR 2.9), low HDL cholesterol (HDL-C) (OR 5.4), and high clotting factor VIII activity (OR 3.6) were significantly associated with cryptogenic brain infarction.
- Gender-specific risk factors were identified: low HDL-C and high factor VIII activity in women; hypertension, current smoking, and low plasma folate in men.
- Several identified risk factors are linked to lifestyle choices.
Conclusions:
- Hypertension, smoking, low HDL-C, and high factor VIII activity are significant risk factors for cryptogenic brain infarction.
- Risk factor profiles differ between men and women, highlighting the need for gender-specific prevention approaches.
- Lifestyle modifications and health education, alongside pharmacological treatments, are essential for stroke prevention.
Abstract:
This case-control study was designed to identify risk factors for cryptogenic brain infarction. We assessed the frequency of prothrombotic states, homocysteine, lipoprotein (a) [Lp(a)] and other lipids and the apolipoprotein E phenotype together with conventional risk factors in 46 patients (19 women and 27 men) with cryptogenic brain infarction aged from 15 to 60 years and in 104 community-based controls. Multivariate odds ratios (ORs) for risk factors and 95% CIs were calculated by logistic regression. Hypertension (OR 4.5; 95% CI, 1.5-13.2; P = 0.006), current smoking (OR 2.9; 95% CI, 1.2-6.8; P = 0.012), low HDL cholesterol (HDL-C) (OR 5.4; 95% CI, 1.1-25.5; P = 0.035) and high clotting factor VIII activity (OR 3.6; 95% CI, 1.1-12.2; P = 0.041) were variables associated with cryptogenic brain infarction. These risk factors were not equally frequent in women and men. Low HDL-C and high factor VIII activity in the women, and hypertension, current smoking and a low level of plasma folate in the men were risk factors for cryptogenic stroke. Several of the observed risk factors for cryptogenic brain infarction were lifestyle-associated, which emphasizes the role of health education in addition to pharmacological treatment in the prevention of stroke.
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