Stroke Risk Factors – Ischaemic, Haemorrhagic, TIA, and Hospital-associated stroke

Ischaemic stroke:

History of transient ischaemic attack (TIA) is an important modifiable risk factor for ischaemic stroke; 12% of ischaemic strokes are preceded by a TIA.12 The risk of post-TIA stroke is greatest within the first 48 hours, risk continues up to 3 months after a TIA.21

Atrial fibrillation is the most common cause of embolic ischaemic stroke, increasing the risk by at least five-fold.28

Aging is a non-modifiable risk factor for ischaemic stroke. Stroke risk doubles every 10 years after age 55 years.29

Stroke risk differs between men and women. In general, women have a higher prevalence and incidence of intracranial aneurysms and subarachnoid hemorrhage, whereas men have higher rates of hemorrhagic stroke. Mortality from stroke is higher in women than men.30,31

Haemorrhagic Stroke:

80% of primary intracerebral haemorrhage (ICH) is due to spontaneous rupture of small vessels due to chronic hypertension.32

Primary ICH can also be caused by amyloid angiopathy, the accumulation of amyloid beta-peptide in small to medium-sized cerebral blood vessels, which may rupture. The condition is more common in individuals above age 70 years.33

Other risk factors for ICH include anticoagulants, antiplatelet therapy and recreational drug use such as cocaine or phenylpropanolamine.34

Congenital vascular abnormalities and malignant brain lesions account for 15% of ICH cases.34

Transient Ischaemic Attack (TIA):

The risk factors for TIA are similar to those for ischaemic stroke and include many modifiable risk factors such as hyperhomocysteinemia, hyperlipidaemia, smoking, obesity, and diabetes. Risk can be reduced substantially by treating hypertension and atrial fibrillation, two conditions commonly associated with older age.21

In-hospital Setting:

In the in-patient setting, the risk factors for stroke include:

  • Traumatic injuries such as hip, pelvic and lower extremity fractures (e.g., from motor vehicle accidents)
  • Acute spinal cord injury or neurosurgical procedures
  • History of inflammatory bowel disease
  • Hypercoagulable states
  • Deep venous thrombosis/pulmonary embolism
  • Urological and gynecological procedures
  • Immobility or being bed-bound

Knowing stroke risk factors and following evidence-based guidelines for early stroke management provides optimum patient care.