Risk Factors and Prevention

Larry B. Goldstein, Sudha Seshadri, Ralph L. Sacco

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


This chapter summarizes key evidence on the determinants of stroke, focusing on risk factors that are relatively common and modifiable, and interventions intended to reduce the risk of a first stroke. Data from large, prospective epidemiologic cohort studies and selected clinical trial data are summarized. Carotid bruits increase the risk of stroke two-to threefold but should be considered as markers of systemic atherosclerotic burden rather than as an indicator of local stenosis in asymptomatic patients. Major risk factors for stroke include elevated blood pressure, diabetes, smoking, prior cardiovascular events or current cardiovascular diseases (coronary heart disease, heart failure, atrial fibrillation, peripheral vascular disease), obesity, low high-density lipoproteins (HDL) cholesterol, low levels of physical activity, a positive family history of stroke before age 65, and several circulating biomarkers such as homocysteine levels and indices of inflammation. The metabolic syndrome, use of oral contraceptives and estrogen replacement after menopause, migraine, heavy alcohol use, obstructive sleep apnea syndrome, stress, HIV, cocaine use, air pollution, and social networks are other potential stroke risk factors and are also discussed. Risk factors tend to cluster and need to be considered together in estimating stroke risk in individuals; the Framingham Stroke Risk Profile can help predict the risk of stroke and the General Cardiovascular Risk Score and Atherosclerosis Pooled Risk Calculator can each predict the combined 10-year risk of cardiovascular and stroke events. Treatments for elevated blood pressure and hypertension, diabetes, hypercholesterolemia, and atrial fibrillation are among those that can reduce the risk of a first stroke.

Original languageEnglish
Title of host publicationStroke
Subtitle of host publicationPathophysiology, Diagnosis, and Management
Pages187 and 206.e6
ISBN (Electronic)9780323694247
StatePublished - Jan 1 2021

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Inc.

ASJC Scopus subject areas

  • General Medicine


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