IDENTIFYING PATIENT POPULATIONS AT HIGH-RISK FOR STROKE

Although the treatment of acute ischemic stroke has improved, the grea test reductions in stroke mortality and morbidity may possibly be achi eved through more effective prevention strategies. Toward this goal, r isk factor profiles for initial and recurrent stroke have been identif ied through longitudinal epidemiologic studies. Nonmodifiable risk mar kers for initial ischemic stroke include age, sex, family history, and race/ethnicity. Modifiable risk factors for first ischemic stroke inc lude hypertension, cardiac disease (particularly atrial fibrillation), diabetes, hyperlipidemia, cigarette smoking, alcohol abuse, physical inactivity, asymptomatic carotid stenosis, and transient ischemic atta ck. As improved acute treatments increase survival after a first strok e, the threat of increased morbidity from stroke recurrence will have greater significance. The risk and specific determinants of early and late stroke recurrence are the subject of ongoing investigations. Age, stroke syndrome, hypertension, cardiac disease (particularly congesti ve heart failure), hyperglycemia, and alcohol abuse have been identifi ed as predictors of late stroke recurrence. Now that many risk factors are established, greater emphasis should be placed on identifying hig h stroke-risk patient populations for intensive risk factor modificati on and antithrombotic treatments. Better understanding and management of stroke risk factors will undoubtedly improve our ability to prevent first and recurrent ischemic stroke.