Background: The prevalence of risk factors for ischemic stroke may vary between different groups of stroke patients. We examined the distribution of individual well-established risk factors as well as the multiplicity of risk factors in different age groups and among subtypes. Methods: In the Lund Stroke Register, we consecutively enrolled 2,505 patients with first-ever ischemic stroke from 2001 to 2009 and registered hypertension, diabetes mellitus, heart disease, current smoking, hypercholesterolemia as well as stroke subtype. Results: Among young patients (<55 years), at least 50% had ≥2 risk factors and 20-25% had ≥3 risk factors. In patients aged 55 years or older, the proportion with ≥2 risk factors was 70-80% and with ≥3 risk factors 35-45%. Men and women had a similar burden of risk factors. Approximately 50% of the cases classified as cardioembolism (CE) and large artery atherosclerosis (LAA) had ≥3 risk factors, which was significantly more than the other TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes (CE p < 0.001, LAA p = 0.001). Conclusions: The prevalence of well-established risk factors is similar among young and old stroke patients with large proportions (50-80%) having ≥2 risk factors. Even though the prevalence of well-established risk factors differs between pathogenetic subtypes, these risk factors as well as the multiplicity of risk factors seem to be of clinical importance in all major subtypes of ischemic stroke.

1.
Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, et al: Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK, from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925-1933.
2.
Béjot Y, Osseby GV, Gremeaux V, Durier J, Rouaud O, Moreau T, et al: Changes in risk factors and preventive treatments by stroke subtypes over 20 years: a population-based study. J Neurol Sci 2009;287:84-88.
3.
O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al: Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112-123.
4.
Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al: Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:517-584.
5.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al: A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2224-2260.
6.
Putaala J, Haapaniemi E, Kaste M, Tatlisumak T: How does number of risk factors affect prognosis in young patients with ischemic stroke? Stroke 2012;43:356-361.
7.
Von Sarnowski B, Putaala J, Grittner U, Gaertner B, Schminke U, Curtze S, et al: Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study. Stroke 2013;44:119-125.
8.
Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al: Lifetime risks of cardiovascular disease. N Engl J Med 2012;366:321-329.
9.
Tanizaki Y, Kiyohara Y, Kato I, Iwamoto H, Nakayama K, Shinohara N, et al: Incidence and risk factors for subtypes of cerebral infarction in a general population: the Hisayama study. Stroke 2000;31:2616-2622.
10.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
11.
Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ: An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005;58:688-697.
12.
Ay H, Benner T, Arsava EM, Furie KL, Singhal AB, Jensen MB, et al: A computerized algorithm for etiologic classification of ischemic stroke: the Causative Classification of Stroke System. Stroke 2007;38:2979-2984.
13.
Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M, et al: The Causative Classification of Stroke System: an international reliability and optimization study. Neurology 2010;75:1277-1284.
14.
Hallström B, Jönsson A-C, Nerbrand C, Norrving B, Lindgren A: Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future. Stroke 2008;39:10-15.
15.
Jönsson A-C, Lindgren I, Hallström B, Norrving B, Lindgren A: Prevalence and intensity of pain after stroke: a population based study focusing on patients' perspectives. J Neurol Neurosurg Psychiatry 2006;77:590-595.
16.
Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. 1. Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-553.
17.
Hart RG: Cardiogenic embolism to the brain. Lancet 1992;339:589-594.
18.
Gardner MJ, Altman DG: Calculating confidence intervals for proportions and their differences; in Gardner MJ, Altman DG (eds): Statistics with Confidence. London, BMJ Publishing Group, 1989, pp 28-29.
19.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380:37-43.
20.
Jackson CA, Hutchison A, Dennis MS, Wardlaw JM, Lindgren A, Norrving B, et al: Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke 2010;41:624-629.
21.
Marini C, Baldassarre M, Russo T, De Santis F, Sacco S, Ciancarelli I, et al: Burden of first-ever ischemic stroke in the oldest old: evidence from a population-based study. Neurology 2004;62:77-81.
22.
Saposnik G, Hill MD, O'Donnell M, Fang J, Hachinski V, Kapral MK: Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke 2008;39:2318-2324.
23.
Leyden JM, Kleinig TJ, Newbury J, Castle S, Cranefield J, Anderson CS, et al: Adelaide stroke incidence study: Declining stroke rates but many preventable cardioembolic strokes. Stroke 2013;44:1226-1231.
24.
Amarenco P, Labreuche J: Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol 2009;8:453-463.
25.
Hallström B, Jönsson A-C, Nerbrand C, Petersen B, Norrving B, Lindgren A: Lund Stroke Register: hospitalization pattern and yield of different screening methods for first-ever stroke. Acta Neurol Scand 2007;115:49-54.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.