Student or educator? Sign up with your school email and get 6 months of Pro free.
CoChat
Sign Up
Cited by 634

The DOI matches its Crossref record; 23 of the 23 references it cites were found in a registry or an index.

Stroke Epidemiology and Risk Factor Management

Guzik, Amy, Bushnell, Cheryl·2017·Continuum
DOI 10.1212/con.0000000000000416
Open this paper in CoChat — free account

Abstract

PURPOSE OF REVIEW: Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity. This article reviews the current recommendations for the management of each of these modifiable risk factors. RECENT FINDINGS: It has been documented that some blood pressure medications may increase variability of blood pressure and ultimately increase the risk for stroke. Stroke prevention typically includes antiplatelet therapy (unless an indication for anticoagulation exists), so the most recent evidence supporting use of these drugs is reviewed. In addition, emerging risk factors, such as obstructive sleep apnea, electronic cigarettes, and elevated lipoprotein (a), are discussed. SUMMARY: Overall, secondary stroke prevention includes a multifactorial approach. This article incorporates evidence from guidelines and published studies and uses an illustrative case study throughout the article to provide examples of secondary prevention management of stroke risk factors.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1212/con.0000000000000416

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

1 retracted

Show all 23 references

Research works printed but not linked: 69

  1. O’Carroll CB Barrett KM. Cardioembolic stroke. Continuum (Minneap Minn) 2017;23(1 Cerebrovascular Disease):XX–XX.
  2. Howard VJ McClure LA Meschia JF. High prevalence of stroke symptoms among persons without a diagnosis of stroke or transient ischemic attack in a general population: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Arch Intern Med 2006;166(18):1952–1958. doi:10.1001/archinte.166.18.1952. · DOI
  3. Dhamoon MS Sciacca RR Rundek T. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology 2006;66(5):641–646. doi:10.1212/01.wnl.0000201253.93811.f6. · DOI · Paper page
  4. Feng W Hendry RM Adams RJ. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology 2010;74(7):588–593. doi:10.1212/WNL.0b013e3181cff776. · DOI
  5. Fang MC Coca Perraillon M Ghosh K. Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008. Am J Med 2014;127(7):608–615. doi:10.1016/j.amjmed.2014.03.017. · DOI
  6. Hong KS Yegiaian S Lee M. Declining stroke and vascular event recurrence rates in secondary prevention trials over the past 50 years and consequences for current trial design. Circulation 2011;123(19):2111–2119. doi:10.1161/CIRCULATIONAHA.109.934786. · DOI
  7. Lee BI Nam HS Heo JH. Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions. Cerebrovasc Dis 2001;12(3):145–151.
  8. Sealy-Jefferson S Wing JJ Sánchez B. Age- and ethnic-specific sex differences in stroke risk. Gend Med 2012;9(2):121–128. doi:10.1016/j.genm.2012.02.002. · DOI
  9. Seshadri S Beiser A Kelly-Hayes M. The lifetime risk of stroke: estimates from the Framingham Study. Stroke 2006;37(2):345–350. doi:10.1161/01.STR.0000199613.38911.b2. · DOI · Paper page
  10. Howard VJ Kleindorfer DO Judd SE. Disparities in stroke incidence contributing to disparities in stroke mortality. Ann Neurol 2011;69(4):619–627. doi:10.1002/ana.22385. · DOI · Paper page
  11. Kleindorfer DO Khoury J Moomaw CJ. Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke J Cereb Circ 2010;41(7):1326–1331. doi:10.1161/STROKEAHA.109.575043. · DOI · Paper page
  12. Morgenstern LB Smith MA Lisabeth LD. Excess stroke in Mexican Americans compared with non-Hispanic Whites: the Brain Attack Surveillance in Corpus Christi Project. Am J Epidemiol 2004;160(4):376–383. doi:10.1093/aje/kwh225. · DOI · Paper page
  13. Howard G Anderson R Johnson NJ. Evaluation of social status as a contributing factor to the stroke belt region of the United States. Stroke 1997;28(5):936–940. doi:10.1161/01.STR.28.5.936. · DOI
  14. Krishnamurthi RV Feigin VL Forouzanfar MH. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health 2013;1(5):e259–e281. doi:10.1016/S2214-109X(13)70089-5. · DOI · Paper page
  15. Howard G Cushman M Kissela BM. Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half-full (empty?) glass. Stroke 2011;42(12):3369–3375. doi:10.1161/STROKEAHA.111.625277. · DOI · Paper page
  16. James PA Oparil S Carter BL. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311(5):507–520. doi:10.1001/jama.2013.284427. · DOI · Paper page
  17. Go AS Bauman MA Coleman King SM. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol 2014;63(12):1230–1238. doi:10.1016/j.jacc.2013.11.007. · DOI
  18. Rothwell PM Howard SC Dolan E. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol 2010;9(5):469–480. doi:10.1016/S1474-4422(10)70066-1. · DOI · Paper page
  19. Appel LJ Moore TJ Obarzanek E. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997;336(17):1117–1124. · DOI · Paper page
  20. Stone NJ Robinson JG Lichtenstein AH. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63(25 pt B):2889–2934. doi:10.1016/j.jacc.2013.11.002. · DOI · Paper page
  21. Stroes ES Thompson PD Corsini A. Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J 2015;36(27):1012–1022. doi:10.1093/eurheartj/ehv043. · DOI · Paper page
  22. Tomlinson SS Mangione KK. Potential adverse effects of statins on muscle. Phys Ther 2005;85(5):459–465. · DOI
  23. Hsue PY Bittner VA Betteridge J. Impact of female sex on lipid lowering, clinical outcomes, and adverse effects in atorvastatin trials. Am J Cardiol 2015;115(4):447–453. doi:10.1016/j.amjcard.2014.11.026. · DOI
  24. Kaplan RC Tirschwell DL Longstreth WTJr. Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology 2005;65(6):835–842. doi:10.1212/01.wnl.0000176058.09848.bb. · DOI
  25. Chamberlain JJ Rhinehart AS Shaefer CFJr Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med 2016;164(8):542–552. doi:10.7326/M15-3016. · DOI · Paper page
  26. Wilcox R Bousser MG Betteridge DJ. Effects of pioglitazone in patients with type 2 diabetes with or without previous stroke: results from PROactive (PROspective pioglitAzone Clinical Trial In macroVascular Events 04). Stroke 2007;38(3):865–873. doi:10.1161/01.STR.0000257974.06317.49. · DOI · Paper page
  27. Bushnell C McCullough LD Awad IA. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45(5):1545–1588. doi:10.1161/01.str.0000442009.06663.48. · DOI · Paper page
  28. Meschia JF Bushnell C Boden-Albala B. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45(12):3754–3832. doi:10.1161/STR.0000000000000046. · DOI · Paper page
  29. Nakamura K Barzi F Lam TH. Cigarette smoking, systolic blood pressure, and cardiovascular diseases in the Asia-Pacific region. Stroke 2008;39(6):1694–1702. doi:10.1161/STROKEAHA.107.496752. · DOI
  30. Mills EJ Wu P Lockhart I. Comparisons of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: a systematic review and multiple treatment meta-analysis. Ann Med 2012;44(6):588–597. doi:10.3109/07853890.2012.705016. · DOI
  31. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary. Respir Care 2008;53(9):1217–1222.
  32. Malek AM Cushman M Lackland DT. Secondhand smoke exposure and stroke: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Prev Med 2015;49(6):e89–e97. doi:10.1016/j.amepre.2015.04.014. · DOI
  33. Herman PM Walsh ME. Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after implementation of Arizona’s comprehensive statewide smoking ban. Am J Public Health 2011;101(3):491–496. doi:10.2105/AJPH.2009.179572. · DOI · Paper page
  34. Piano MR Benowitz NL Fitzgerald GA. Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation 2010;122(15):1520–1544. doi:10.1161/CIR.0b013e3181f432c3. · DOI
  35. Yatsuya H Folsom AR, ARIC Investigators. Risk of incident cardiovascular disease among users of smokeless tobacco in the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 2010;172(5):600–605. doi:10.1093/aje/kwq191. · DOI
  36. Hansson J Galanti MR Hergens MP. Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival. J Intern Med 2014;276(1):87–95. doi:10.1111/joim.12219. · DOI · Paper page
  37. Bhatnagar A Whitsel LP Ribisl KM. Electronic cigarettes: a policy statement from the American Heart Association. Circulation 2014;130(16):1418–1436. doi:10.1161/CIR.0000000000000107. · DOI · Paper page
  38. Burns DM. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis 2003;46(1):11–29. doi:10.1016/S0033-0620(03)00079-3. · DOI · Paper page
  39. Joshipura KJ Ascherio A Manson JE. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999;282(13):1233–1239. doi:10.1001/jama.282.13.1233. · DOI · Paper page
  40. 10.1136/bmj.e6698 · DOI · Paper page
  41. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Chapter 1: key elements of healthy eating patterns. In: 2015-2020 Dietary guidelines for Americans. 8th edition. health.gov/dietaryguidelines/2015/guidelines/chapter-1/examples-of-other-healthy-eating-patterns/. Published December 2015. Accessed November 29 2016.
  42. Tsivgoulis G Psaltopoulou T Wadley VG. Adherence to a Mediterranean diet and prediction of incident stroke. Stroke 2015;46(3):780–785. doi:10.1161/STROKEAHA.114.007894. · DOI
  43. Martínez-González MÁ Toledo E Arós F. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation 2014;130(1):18–26. doi:10.1161/CIRCULATIONAHA.113.006921. · DOI
  44. Tuttolomondo A Casuccio A Buttà C. Mediterranean diet in patients with acute ischemic stroke: relationships between Mediterranean diet score, diagnostic subtype, and stroke severity index. Atherosclerosis 2015;243(1):260–267. doi:10.1016/j.atherosclerosis.2015.09.017. · DOI
  45. Strazzullo P D’Elia L Kandala NB Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 2009;339:b4567. doi:10.1136/bmj.b4567. · DOI · Paper page
  46. Rexrode KM Hennekens CH Willett WC. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997;277(19):1539–1545. doi:10.1001/jama.1997.03540430051032. · DOI · Paper page
  47. Kernan WN Inzucchi SE Sawan C. Obesity: a stubbornly obvious target for stroke prevention. Stroke 2013;44(1):278–286. doi:10.1161/STROKEAHA.111.639922. · DOI
  48. Ryan AS Dobrovolny CL Smith GV. Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients. Arch Phys Med Rehabil 2002;83(12):1703–1707. doi: 10.1053/apmr.2002.36399. · DOI · Paper page
  49. De Deyne PG Hafer-Macko CE Ivey FM. Muscle molecular phenotype after stroke is associated with gait speed. Muscle Nerve 2004;30(2):209–215. doi:10.1002/mus.20085 · DOI
  50. Caspersen CJ Powell KE Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985;100(2):126–131.
  51. Gordon NF Gulanick M Costa F. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientificstatement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Circulation 2004;109(16):2031–2014. doi:0.1161/01.CIR.0000126280.65777.A4. · DOI · Paper page
  52. Berra K Rippe J Manson JE. Making physical activity counseling a priority in clinical practice: the time for action is now. JAMA 2015;314(24):2617–2618. doi:10.1001/jama.2015.16244. · DOI
  53. Brown DL Mowla A McDermott M. Ischemic stroke subtype and presence of sleep-disordered breathing: the BASIC sleep apnea study. J Stroke Cerebrovasc Dis 2015;24(2):388–393. doi:10.1016/j.jstrokecerebrovasdis.2014.09.007. · DOI
  54. Martínez-García MA Campos-Rodríguez F Soler-Cataluña JJ. Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment. Eur Respir J 2012;39(4):906–912. doi:10.1183/09031936.00011311. · DOI
  55. Culebras A. Sleep apnea and stroke. Curr Neurol Neurosci Rep 2015;15(1):503. doi:10.1007/s11910-014-0503-3. · DOI
  56. Epstein LJ Kristo D Strollo PJJr. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5(3):263–276. · DOI · Paper page
  57. Loscalzo J. Lipoprotein(a). A unique risk factor for atherothrombotic disease. Arteriosclerosis 1990;10(5):672–679. doi:10.1161/01.ATV.10.5.672. · DOI · Paper page
  58. Schreiner PJ Heiss G Tyroler HA. Race and gender differences in the association of Lp(a) with carotid artery wall thickness. The Atherosclerosis Risk in Communities (ARIC) study. Arterioscler Thromb Vasc Biol 1996;16(3):471–478. doi: 10.1161/01.ATV.16.3.471. · DOI
  59. Sultan SM Schupf N Dowling MM. Review of lipid and lipoprotein(a) abnormalities in childhood arterial ischemic stroke. Int J Stroke 2014;9(1):79–87. doi:10.1111/ijs.12136. · DOI
  60. Smolders B Lemmens R Thijs V. Lipoprotein (a) and stroke: a meta-analysis of observational studies. Stroke 2007;38(6):1959–1966. doi:10.1161/STROKEAHA.106.480657. · DOI
  61. Ohira T Schreiner PJ Morrisett JD. Lipoprotein(a) and incident ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study. Stroke 2006;37(6):1407–1412. doi:10.1161/01.STR.0000222666.21482.b6. · DOI
  62. Boden-Albala B Kargman DE Lin IF. Increased stroke risk and lipoprotein(a) in a multiethnic community: the Northern Manhattan Stroke Study. Cerebrovasc Dis 2010;30(3):237–243. doi:10.1159/000319065. · DOI
  63. Kostner KM März W Kostner GM. When should we measure lipoprotein(a)? Eur Heart J 2013;34(42):3268–3276. doi:10.1093/eurheartj/eht053. · DOI
  64. Johnson ES Lanes SF Wentworth CE3rd. A metaregression analysis of the dose-response effect of aspirin on stroke. Arch Intern Med 1999;159(11):1248–1253. doi:10.1001/archinte.159.11.1248. · DOI
  65. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324(7329):71–86. doi:10.1136/bmj.324.7329.71. · DOI · Paper page
  66. Diener H Cunha L Forbes C. European Stroke Prevention Study. 2. Dypyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996;143(1-2):1–13. doi:10.1016/S0022-510X(96)00308-5. · DOI · Paper page
  67. Diener HC Bogousslavsky J Brass LM. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004;364(9431):331–337. doi:10.1016/S0140-6736(04)16721-4. · DOI · Paper page
  68. Bhatt DL Fox KAA Hacke W. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006;354(16):1706–1717. doi:10.1056/NEJMoa060989. · DOI · Paper page
  69. Hackam DG Spence JD. Combining multiple approaches for the secondary prevention of vascular events after stroke. Stroke 2007;38(6):1881–1885. doi:10.1161/STROKEAHA.106.475525. · DOI · Paper page

Cited by

Metadata

Authors
Guzik, A., & Bushnell, C.
Venue
Continuum
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-02
Volume
23
Issue
1
Pages
15-39
ISSN
  • 1080-2371 (ISSN-L)
  • 1538-6899
DOI
10.1212/con.0000000000000416
OpenAlex
W2586368855
Cited by
634
References
23
FWCI
23.00
Type
journal article
Language
en
Open access
closed

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.