Hankey Graeme J
Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington St, Perth, Australia, 6001.
Stroke. 2006 Aug;37(8):2181-8. doi: 10.1161/01.STR.0000229883.72010.e4. Epub 2006 Jun 29.
About 60% to 80% of all ischemic strokes can be attributed to increasing blood pressure, blood cholesterol, cigarette smoking, carotid stenosis, and diabetes mellitus (atherosclerotic ischemic stroke), and atrial fibrillation and valvular heart disease (cardiogenic ischemic stroke). The aim of this review was to examine the potential role of other risk factors in the etiology of ischemic stroke.
About 10% to 20% of atherosclerotic ischemic strokes can probably be attributed to recently established, causal risk factors for ischemic heart disease: raised apoB/apoA 1 ratio, obesity, physical inactivity, pyschosocial stress and low fruit and vegetable intake. However, their causal role remains to be proven. The direct genetic contribution of any single gene towards ischemic stroke is likely to be modest and apply in selected patients only and in combination with environmental factors or via other epistatic (gene-gene or gene-environmental) effects.
Research resources should not be allocated disproportionately to emerging novel risk factors that may account for up to only 20% of all strokes at the expense of researching the determinants of the relatively few established causal factors that account for up to 80% of all strokes.
所有缺血性卒中中，约60%至80%可归因于血压升高、血胆固醇、吸烟、颈动脉狭窄和糖尿病（动脉粥样硬化性缺血性卒中），以及心房颤动和心脏瓣膜病（心源性缺血性卒中）。本综述的目的是研究其他危险因素在缺血性卒中病因学中的潜在作用。
约10%至20%的动脉粥样硬化性缺血性卒中可能归因于最近确定的缺血性心脏病的因果危险因素：载脂蛋白B/载脂蛋白A 1比值升高、肥胖、身体活动不足、心理社会压力以及水果和蔬菜摄入量低。然而，它们的因果作用仍有待证实。任何单个基因对缺血性卒中的直接遗传贡献可能较小，仅适用于特定患者，并与环境因素结合或通过其他上位性（基因-基因或基因-环境）效应起作用。
研究资源不应不成比例地分配给可能仅占所有卒中20%的新出现的危险因素，而牺牲对占所有卒中80%的相对较少已确定因果因素的决定因素的研究。
