Stroke Risk Factors, Genetics, and Prevention

Abstract

Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.

Blood pressure targets in type 2 diabetes. Evidence against or in favour of an aggressive approach

“…Furthermore, similar observations have been made by post hoc analyses of the individuals at high CV risk, largely or exclusively with diabetes, in the ONTARGET, INVEST and VALUE trials [19][20][21]. Finally, reducing SBP to <130 mmHg has been shown to much more effectively protect against haemorrhagic stroke (a cerebrovascular event that is much rarer than ischaemic stroke but often with more serious clinical sequelae) than reducing SBP to <140 mmHg [25]. In the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, people with documented lacunar strokes exhibited a 63% reduction in the risk of intracerebral haemorrhage, although not of other vascular outcomes, if SBP was reduced to 127 mmHg rather than to 138 mmHg [26].…”

The association analysis between CYP24A1 genetic polymorphisms and the risk of ischemic stroke in Chinese Han population

“…Stroke is divided into ischemic stroke (85% of all strokes) and hemorrhagic stroke (15% of all stroke). In addition, genetic factor was also known to be a very important risk factor for stroke (Boehme, Esenwa, & Elkind, 2017). There are many risk factors for the development of stroke, such as race, sex, age, hypertension, diabetes mellitus, obesity, atherosclerosis, and dyslipidemia (Bhat et al, 2008;Hankey, 2003;Khoury et al, 2013;Kleindorfer et al, 2010;Tirschwell et al, 2004).…”

Attenuation of Myeloid-Specific TGFβ Signaling Induces Inflammatory Cerebrovascular Disease and Stroke

“…Although there is no mouse homolog of CECR1 (encoding ADA2), DADA2 patients provide valuable insight into myeloid cell function, inflammation and stroke risk. In fact there is increasing evidence for roles of inflammation in stroke etiology 33,34 . In particular, a recent clinical trial using anti-inflammatory therapy targeting interleukin-1β led to a significant decrease in strokes in cardiovascular patients with high C-reactive protein 35 .…”