Identifying patient populations at high risk for stroke.

Although the treatment of acute ischemic stroke has improved, the greatest reductions in stroke mortality and morbidity may possibly be achieved through more effective prevention strategies. Toward this goal, risk factor profiles for initial and recurrent stroke have been identified through longitudinal epidemiologic studies. Nonmodifiable risk markers for initial ischemic stroke include age, sex, family history, and race/ethnicity. Modifiable risk factors for first ischemic stroke include hypertension, cardiac disease (particularly atrial fibrillation), diabetes, hyperlipidemia, cigarette smoking, alcohol abuse, physical inactivity, asymptomatic carotid stenosis, and transient ischemic attack. As improved acute treatments increase survival after a first stroke, the threat of increased morbidity from stroke recurrence will have greater significance. The risk and specific determinants of early and late stroke recurrence are the subject of ongoing investigations. Age, stroke syndrome, hypertension, cardiac disease (particularly congestive heart failure), hyperglycemia, and alcohol abuse have been identified as predictors of late stroke recurrence. Now that many risk factors are established, greater emphasis should be placed on identifying high stroke-risk patient populations for intensive risk factor modification and antithrombotic treatments. Better understanding and management of stroke risk factors will undoubtedly improve our ability to prevent first and recurrent ischemic stroke.