Stroke Prevention: Key Risk Factors and Protection Strategies

Introduction: Stroke — A Preventable Threat

Stroke is one of the leading causes of mortality and permanent disability worldwide. It is an acute cerebrovascular accident that can lead to severe and irreversible consequences, significantly reducing the quality of life of patients and their loved ones [2]. However, many strokes can be prevented if risk factors are identified and managed effectively in a timely manner. Understanding these factors and applying preventive measures is the key to preserving brain health and a long, fulfilling life.

What is a Stroke and What Are Its Types?

A stroke occurs when the blood supply to a part of the brain is disrupted, leading to the death of brain cells due to a lack of oxygen and nutrients. There are two main types of stroke:

• Ischemic stroke: The most common type, caused by the blockage of a blood vessel supplying blood to the brain (e.g., by a blood clot).
• Hemorrhagic stroke: Occurs when a blood vessel in the brain ruptures, leading to bleeding into the brain tissue. Intracerebral hemorrhage (ICH) is a dramatic condition caused by the rupture of a cerebral vessel and the penetration of blood into the brain parenchyma [2].

Hemorrhagic stroke contributes significantly to stroke-related mortality and disability: only half of patients survive within a year after ICH, and survivors often face consequences that affect their quality of life [2].

Main Stroke Risk Factors: What You Need to Know

Stroke risk factors can be divided into modifiable (those that can be changed) and non-modifiable (those that cannot be changed). Understanding these factors is critical for effective prevention.

• Age: The risk of stroke increases significantly with age. For example, patients over 75 years old more frequently have comorbid conditions, such as atrial fibrillation, and they are less likely to receive recommended therapy after myocardial infarction, indirectly indicating increased risks of cardiovascular events, including stroke [3].
• High blood pressure (hypertension): This is one of the most significant risk factors. High systolic blood pressure is associated with an increased risk of rebleeding in aneurysmal subarachnoid hemorrhage [6].
• Use of antithrombotic agents: The increased use of antithrombotic drugs in recent decades has led to a rise in the frequency of intracerebral hemorrhages [2].
• Stroke severity and cerebral cortex involvement: Severe strokes (odds ratio [OR] 2.68) and cerebral cortex involvement (OR 3.09) significantly increase the risk of early post-stroke seizures [1].
• Hemorrhagic stroke: In itself, it is a risk factor for early post-stroke seizures (OR 2.14) and post-stroke epilepsy [1].
• Presence of an aneurysm: Aneurysms larger than 10 mm and posterior circulation aneurysms increase the risk of rebleeding [6].

Specific Risks of Hemorrhagic Stroke and Its Consequences

Intracerebral hemorrhage (ICH) is a medical emergency in which blood from a ruptured vessel spills directly into the brain tissue. The pathophysiology of ICH is complex and involves mechanical mass effect, hematoma expansion, and secondary injury [2].

A key therapeutic goal in ICH is to prevent hematoma expansion [2]. Studies show that drugs such as andexanet alfa may reduce the risk of hematoma expansion in patients with intracranial hemorrhage associated with factor Xa inhibitors, though they may increase the risk of arterial thromboembolic events [4].

Rebleeding is a severe complication of aneurysmal subarachnoid hemorrhage (aSAH). The highest rates of rebleeding occur within the first 6 hours after the initial aSAH [6]. Factors contributing to rebleeding include high systolic blood pressure, poor neurological status (Hunt-Hess grade III-IV), intracerebral or intraventricular hematomas, posterior circulation aneurysms, and aneurysms larger than 10 mm [6].

Post-stroke seizures and epilepsy are also frequent complications. A meta-analysis showed that the incidence of early post-stroke seizures (within 7 days) is 7%, and post-stroke epilepsy (at least one unprovoked seizure) is 10% [1]. These rates are higher in children than in adults [1].

The Relationship Between Stroke and Other Diseases

• Multiple Sclerosis (MS): Observational studies show that the incidence of stroke in patients with multiple sclerosis is higher compared to the general population [7]. A systematic review and meta-analysis confirm that the relative risk of stroke in patients with MS is 2.55 times higher than in the general population [8]. MS and stroke share common risk factors and immune mechanisms, and inflammation in autoimmune diseases may predispose individuals to an increased risk of stroke [7].
• Inflammatory Bowel Disease (IBD): Patients with IBD, especially those receiving immunomodulators and biologic therapies, may be at an increased risk for infections and require specialized preventive care, including timely vaccination, osteoporosis screening, and cervical cancer screening [5]. Although a direct link between IBD and stroke is not stated in the sources, the importance of comprehensive preventive care for patients with chronic conditions emphasizes the need for close attention to their overall health, which indirectly helps reduce vascular risks.

Effective Stroke Prevention Strategies

Stroke prevention includes a set of measures aimed at reducing modifiable risk factors:

• Blood pressure control: Regular monitoring and maintaining blood pressure within normal limits through diet, physical activity, and, if necessary, medication therapy [6].
• Management of chronic conditions: Effective treatment of diabetes, high cholesterol, atrial fibrillation, and other cardiovascular diseases.
• Healthy lifestyle: A balanced diet, regular physical exercise, quitting smoking, and moderate alcohol consumption.
• Regular medical check-ups: Especially important for older adults and patients with comorbid conditions for the timely detection and correction of risk factors [3].
• Special attention to patients on anticoagulants: Careful monitoring and dosage management to minimize the risk of hemorrhage [2, 4].
• Specific prevention for at-risk groups: For example, for patients with MS, it is important to recognize the increased risk of stroke and work with a doctor to control general vascular factors [7, 8]. Patients with IBD, especially those on immunosuppressants, require comprehensive preventive care, including up-to-date vaccinations [5].
• Early detection and treatment of aneurysms: When indicated, especially for large aneurysms or those in the posterior circulation [6].

Stroke prevention is a continuous process that requires a conscious approach to one's health and close cooperation with medical specialists. Timely identification and correction of risk factors can significantly reduce the likelihood of developing this severe disease.

Sources

1. [1] Incidence and risk factors of post-stroke seizures and epilepsy: systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/38008901/
2. [2] Intracerebral haemorrhage. https://pubmed.ncbi.nlm.nih.gov/36928219/
3. [3] Differences in Characteristics and Clinical Outcomes According to Age in Patients Following High-Risk Myocardial Infarction: Insights from PARADISE-MI. https://pubmed.ncbi.nlm.nih.gov/40780448/
4. [4] Association of Biomarkers With Intracerebral Hematoma Expansion and Arterial Thromboembolic Events in Patients With Acute Intracranial Hemorrhage: The ANNEXA-I Biomarker Substudy. https://pubmed.ncbi.nlm.nih.gov/40289797/
5. [5] ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. https://pubmed.ncbi.nlm.nih.gov/28071656/
6. [6] Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis. https://pubmed.ncbi.nlm.nih.gov/24911172/
7. [7] Stroke risk in multiple sclerosis: a critical appraisal of the literature. https://pubmed.ncbi.nlm.nih.gov/35369835/
8. [8] Prevalence and epidemiology of stroke in patients with multiple sclerosis: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/38573365/

Disclaimer: The information presented in this article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always consult your healthcare provider with any questions regarding your health or medical condition.