 |
|
 |
 Risk factors
| S
6-1 |
Epidemiological studies
have identified several risk factors for stroke. Some factors (e.g. age)
cannot be modified; nevertheless they contribute to define the risk
classes. Other factors can be modified through pharmacological or
non-pharmacological interventions, and their identification is crucial to
primary and secondary stroke prevention. |
|
S 6-2 a |
Risk factor for cerebral haemorrhage are:
 | non modifiable: age; non-Caucasian
ethnicity; |
| modifiable: arterial
hypertension, excessive alcohol consumption, cigarette smoking. |
|
|
S 6-2 b |
The thrombolytic therapy and the anticoagulant therapy
during the acute phase and in the prevention of ischaemic stroke increase
the risk of cerebral haemorrhage, not significantly among those with atrial
fibrillation. The antiplatelet therapy increases such risk only to a modest
extent. |
|
S 6-2 c |
The microbleeds identified by gradient-echo MR are
markers of damage to the cerebral small vessels, possibly correlated with a
high risk of parenchymal intracerebral haemorrhage. |
| S
6-3 a |
Well-documented
modifiable risk factors for stroke are:
| arterial hypertension; |
| some heart diseases (particularly atrial fibrillation); |
| diabetes mellitus; |
| hyperhomocysteinaemia; |
| left ventricular hypertrophy; |
| carotid stenosis; |
| cigarette smoking; |
| alcohol abuse; |
| limited physical activity; |
| diet. |
|
| S
6-3 b |
Transient ischaemic
attacks are a well-documented risk factor for stroke. |
| S 6-4 a |
Other probable risk
factors for stroke, which have not been completely documented so far as
independent risk factors, include:
| dyslipidaemia; |
| obesity; |
| metabolic syndrome; |
| some heart diseases (patent foramen ovale, septal aneurysm); |
| plaques of the aortic arch; |
| use of oral contraceptives; |
| hormonal replacement therapy; |
| migraine; |
| antiphospholipid antibodies; |
| haemostasis factors; |
| infections; |
| drug use; |
| air pollution. |
|
| S
6-4 b |
Hypercholesterolemia
is the best documented modifiable risk factor for coronary artery disease,
but its association with stroke is incompletely defined. |
|
S 6-5 |
Age is the major risk factor for stroke. The incidence of stroke increases with
age, and after 55 years it doubles for every decade. The majority of
strokes occur in subjects over 65 years. |
|
S 6-6 |
Predisposition to
stroke may be inherited, although the role of genetic factors in the
pathogenesis of stroke is still undefined. |
|
S 6-7 |
The interaction of the different risk factors is
factorial and the risk of stroke increases more than proportionally with the
number of factors present, even if the individually attributable risk is
limited (provided it is statistically significant). Adequate studies on the
interaction among vascular risk factors are still missing. |
|
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