Risk Factors for Ischemic Stroke

Ischemic stroke can occur in people of all ages, at any time and without predilection for sex or race. Age, however, is the most important determinant of stroke, with most strokes occurring in individuals older than 65. Atherosclerosis affecting the extracranial and intracranial circulation differs according to race and ethnic group. For example, extracranial atherosclerotic lesions are more common in whites, while intracranial lesions are more common in blacks, Hispanics and Asians.

Several disease processes and lifestyle habits can predispose or facilitate cerebral ischemia. For example, following age, hypertension is the most powerful stroke risk factor. People with cardiac disease, specifically with atrial fibrillation, valvular heart disease, coronary artery disease, myocardial infarction, congestive heart failure, as well as those with electrocardio-graphic evidence of left ventricular hypertrophy, are also at an increased risk for ischemic stroke. Other disorders, such as diabetes melli-tus, hypercholesterolemia, sickle cell disease, coagulation deficiencies and non-atherosclerotic vasculopathies, have also been implicated as a cause of ischemic stroke. Physical inactivity, cigarette smoking and heavy alcohol use are also risk factors for ischemic stroke, which are amenable to lifestyle modifications.

Transient ischemic attacks (TIAs), defined as acute, non-convulsive, focal neurological deficit as a result of inadequate blood flow to a vascular distribution and which resolve in less than 24 hours, are strong predictors of subsequent stroke. Most TIAs typically last 2-15 minutes and their incidence increases with age [7]. The first year after a TIA portends the greatest risk of stroke, with an incidence of 1-15%.

Carotid artery disease resulting in a plaque or carotid stenosis has been found to confer an increased risk of stroke, especially in patients with greater than 75% stenosis. An annual

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