Benefits of modifying the predictive factors of stroke recurrence

The risk of stroke recurrence is high. With annual rates of around 4%, accumulative rates of 40% are reached within 10 years. Despite being underestimated, the risk is highest in the early stages; around 12% in the first year. The most important etiological subtypes have different levels of risk; the highest being for atherothrombotic infarction and the lowest for lacunar infarction. Each etiology has its own risk factors. For example, in carotid stenosis, the grade of stenosis, ulceration, and plaque morphology, silent infarction on neuroimaging, coexistence of intracranial disease, or microemboli detected on transcranial Doppler, all have predictive value for stroke recurrence. There is a paucity of data on the risk factors for intracranial stenosis. In cardioembolism due to atrial fibrillation age, coexistence of hypertension or diabetes, and echocardiographic data predict recurrence. Risk factors for recurrence do not parallel those for first stroke. Diabetes is the most consistent risk factor for recurrence in different studies, while control of hypertension has been shown to be effective in the prevention of recurrences. Among the inflammatory markers, C-reactive protein is the most effective in prediction of recurrence. Elevated levels of homocysteine also predict recurrence, but attempts to improve risk by the modification of these levels have, to date, been unsuccessful. To be effective, the modification of predictive factors needs to be multifactorial and should be taken into account corresponding to each etiological type. More research is needed on biological markers to establish their clinical relevance and the benefit of targeting them for therapeutic modification.