A 79-year-old man is admitted with left hemiparesis. CT reveals a middle cerebral
artery infarct. What is his most significant risk factor for stroke?
C. Family history
Ans: Risk factors in stroke
(A) The three most important risk factors for stroke are hypertension, hypertension and hypertension (A)! INTERSTROKE, a recent large case–control study evaluating risk factors for stroke, has shown that ten risk factors are associated with 90 per cent of the risk of stroke and that of these modifiable risk factors, hypertension is the most important for all stroke subtypes and is a particularly dangerous risk factor for intracerebral haemorrhage. Other risk factors include smoking (B), lipids (E) and diabetes (D) which promote atherosclerosis. Poor diet, lack of regular activity and increased waist–hip ratio are as significant risk factors as smoking. Unmodifiable risk factors include increasing age (by far the most significant), male sex, family history (C) and ethnicity (higher in Blacks and Asians). Patients in atrial fibrillation have an annual stroke risk of 5 per cent. This can be lowered to 1 per cent by anticoagulating with warfarin, aiming for an international normalized ratio (INR) of between 2 and 3 (avoid confusion with aspirin which is an antiplatelet). Stroke is the third most common cause of death in England (after heart disease and cancer) and is more often disabling than fatal, so primary and secondary prevention are crucial.