Stroke Modifiable and Non-modifiable Risk Factors

Modifiable Stroke Risk Factors

Patients can play a significant role in stroke risk prevention by controlling the modifiable risk factors with a healthy lifestyle.6,10,20,35-42

Hypertension

Hypertension is a significant risk factor for stroke, and risk increase as blood pressure increase. Professional organizations recommend that all adults 18 years and older be screened for high blood pressure.38

Diet & Nutrition

Diet high in fats, low in green leafy vegetables, or result in high cholesterol level increases the risk of stroke. Increased fruits and vegetables and a low-fat diet reduce stroke risk in a dose-dependent manner. Reducing salt intake and increasing antioxidants, potassium, and calcium have been reported to mitigate stroke risk.39

Cigarette Smoking

Smoking doubles the risk for ischaemic stroke and increases the risk of haemorrhagic stroke 2- to 4-fold. Repeated exposure to environmental (secondhand) smoke also increases the risk of stroke. Smoking cessation reduces stroke risk over time.10

Diabetes

The risk for stroke is higher among individuals with diabetes.40 Type 2 diabetes is associated with an increased prevalence of atherogenic risk factors such as hypertension, obesity, and dyslipidaemia. The combination of hyperglycaemia and hypertension is thought to increase the risk of stroke. The AHA recommends a target blood pressure of <140/90 mm Hg.10 Pharmacological therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) or lipid-lowering statins can reduce stroke risk.10

Obesity and Body Fat Distribution

Excess body fat and obesity increase stroke risk. Weight loss lowers risk factors for stroke by reducing blood pressure and cholesterol. Body fat distribution is an indicator of stroke risk. A high hip-to-waist ratio is a greater risk factor for vascular disease, including stroke, than BMI score alone.10,41

Physical Inactivity

A sedentary lifestyle increases an individual’s chance of stroke. In contrast, routine physical activity prevents stroke. Only moderate-to-vigorous intensity exercise has been found to reduce the stroke incidence. Therefore, patients should be encouraged to engage in aerobic exercise at moderate intensity for 150 minutes or more per week and at vigorous intensity for 75 minutes or more per week.10

Other Modifiable Stroke Risk Factors10,20,35-42

Atrial Fibrillation (AF)

Cardiovascular disease/coronary artery disease/electrocardiogram abnormalities

Alcohol/and recreational drug use

Dyslipidaemia/metabolic syndrome

Infections (e.g., HIV, COVID-19, Helicobacter pylori)

Known Heart Conditions, including Valvular heart disease, unstable and chronic stable angina, acute MI, asymptomatic carotid artery stenosis, and other cardiac conditions

Cerebral aneurysms or arteriovenous malformations

Inflammatory conditions (e.g., lupus or rheumatoid arthritis)

Blood thinners (e.g., warfarin or heparin)

Raised hemoglobin, red cell count, or hematocrit

Liver disease

Depression

Non-Modifiable Stroke Risk Factors1,3,29,30,37

Genetics

Gender

Age

Ethnicity

Previous history of stoke or TIA

Bleeding disorders

Sickle cell disease

low birth weight babies

Geography, such as living in low-to middle-income countries