Stroke is the fourth leading cause of death in the United States (after heart disease, cancer, and chronic lung disease) and the most common disabling neurologic disorder. Approximately 800,000 new strokes occur and approximately 130,000 people die from stroke in the United States each year.
The incidence of stroke increases with age, with approximately two-thirds of all strokes occurring in those older than 65 years. Age-adjusted stroke risk is somewhat higher in men than in women and in blacks > Hispanics > whites. Modifiable risk factors for stroke include systolic or diastolic hypertension, atrial fibrillation, diabetes, dyslipidemia, and physical inactivity (Table 13-1). The incidence of stroke has decreased in recent decades, largely because of improved treatment of hypertension, dyslipidemia, and diabetes, and reduction in smoking.
Table 13-1.Well-Documented Risk Factors for Stroke. |Favorite Table|Download (.pdf) Table 13-1. Well-Documented Risk Factors for Stroke.
|Nonmodifiable risk factors |
Low birth weight
African American ethnicity
Family history of stroke
|Modifiable risk factors |
Hypertension (BP >140 mm Hg systolic or 90 mm Hg diastolic)
Asymptomatic carotid stenosis (>60% diameter)
Peripheral artery disease
Atrial fibrillation (with or without valvular disease)
Congestive heart failure
Coronary artery disease
Postmenopausal hormone therapy (estrogen ± progesterone)
Oral contraceptive use
High total cholesterol (top 20%)
Low HDL cholesterol (<40 mg/dL)
Obesity (especially abdominal)
Sickle cell disease
Genetic factors also appear to be important in stroke pathogenesis, although the cause of most strokes is likely to be multifactorial and involve both polygenic and environmental influences. Several, mostly rare Mendelian disorders have stroke as a major manifestation; some of these, in which the affected gene has been identified, are listed in Table 13-2.
Table 13-2.Some Monogenic Disorders Associated With Stroke. |Favorite Table|Download (.pdf) Table 13-2. Some Monogenic Disorders Associated With Stroke.
|Disorder ||Gene ||Protein ||Inheritance ||Stroke Type |
|Amyloid angiopathy ||APP ||Amyloid βA4 precursor protein ||AD ||ICH |
|Amyloid angiopathy ||BRI ||Integral membrane protein 2B ||AD ||Ischemic |
|Amyloid angiopathy ||CST3 ||Cystatin 3 ||AD ||ICH |
|Arterial tortuosity syndrome ||SLC2A10 ||Solute carrier family 2, member 10 ||AR ||Ischemic |
|Brain small-vessel disease with hemorrhage ||COL4A1 ||Collagen type IV, α-1 chain ||AD ||ICH |
|CADASIL ||NOTCH3 ||Notch-3 ||AD ||Ischemic |
|CARASIL ||HTRA1 ||HTRA serine peptidase 1 ||AR ||Ischemic |
|Cerebral cavernous malformations 1 ||KRIT1 ||KREV interaction trapped 1 ||AD ||ICH |
|Cerebral cavernous malformations 2 ||CCM2 ||Malcavernin ||AD ||ICH |
|Cerebral cavernous malformations 3 ||PDCD10 ||Programmed cell death 10 ||AD ||ICH |
|Ehlers-Danlos syndrome, type IV ||COL3A1 ||Collagen type III, α-1 chain ||AD ||Ischemic (arterial dissection), aneurysmal SAH |
|Fabry disease ||GLA ||α-Galactosidase A ||XLR ||Ischemic...|