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Semin Neurol 2022; 42(05): 571-582
DOI: 10.1055/s-0042-1758703
Review Article

Primary Prevention of Ischemic Stroke

Behnam Sabayan 
1   Department of Neurology, HealthPartners Neuroscience Center, St. Paul, Minnesota
2   Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Abstract

Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke care, primary prevention is still the most cost-effective approach in reducing the burden of ischemic stroke. The two main strategies for primary stroke prevention include population-wide versus high-risk group interventions. Interventions such as increasing access to primary care, regulation of salt and sugar contents in processed foods, public education, and campaigns to control cerebrovascular risk factors are examples of population-wide interventions. High-risk group interventions, on the other hand, focus on recognition of individuals at risk and aim to modify risk factors in a timely and multifaceted manner. This article provides an overview on conventional modifiable risk factors for ischemic stroke and highlights the emerging risk factors and approaches for high-risk group identification and treatment.

Keywords

prevention - ischemic stroke - population - high-risk

Disclosures

The author reports no disclosures relevant to the manuscript.




Publication History

Article published online:
17 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Virani SS, Alonso A, Benjamin EJ. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2020 update: a report from the American Heart Association. Circulation 2020; 141 (09) e139-e596
    CrossrefPubMedGoogle Scholar
  • 2 GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20 (10) 795-820
    CrossrefPubMedGoogle Scholar
  • 3 Go AS, Mozaffarian D, Roger VL. et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation 2014; 129 (03) 399-410
    CrossrefPubMedGoogle Scholar
  • 4 Ebrahim S. Cost-effectiveness of stroke prevention. Br Med Bull 2000; 56 (02) 557-570
    CrossrefPubMedGoogle Scholar
  • 5 Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology 2021; 97 (20, Suppl 2): S6-S16
    CrossrefPubMedGoogle Scholar
  • 6 Skajaa N, Adelborg K, Horváth-Puhó E. et al. Nationwide trends in incidence and mortality of stroke among younger and older adults in Denmark. Neurology 2021; 96 (13) e1711-e1723
    CrossrefPubMedGoogle Scholar
  • 7 Lanas F, Seron P. Facing the stroke burden worldwide. Lancet Glob Health 2021; 9 (03) e235-e236
    CrossrefPubMedGoogle Scholar
  • 8 Pandian JD, Gall SL, Kate MP. et al. Prevention of stroke: a global perspective. Lancet 2018; 392 (10154): 1269-1278
    CrossrefPubMedGoogle Scholar
  • 9 Morgenstern LB, Smith MA, Sánchez BN. et al. Persistent ischemic stroke disparities despite declining incidence in Mexican Americans. Ann Neurol 2013; 74 (06) 778-785
    CrossrefPubMedGoogle Scholar
  • 10 Ovbiagele B, Goldstein LB, Higashida RT. et al; American Heart Association Advocacy Coordinating Committee and Stroke Council. Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke 2013; 44 (08) 2361-2375
    CrossrefPubMedGoogle Scholar
  • 11 Tikk K, Sookthai D, Monni S. et al. Primary preventive potential for stroke by avoidance of major lifestyle risk factors: the European Prospective Investigation into Cancer and Nutrition-Heidelberg cohort. Stroke 2014; 45 (07) 2041-2046
    CrossrefPubMedGoogle Scholar
  • 12 O'Donnell MJ, Chin SL, Rangarajan S. et al; INTERSTROKE Investigators. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016; 388 (10046): 761-775
    CrossrefPubMedGoogle Scholar
  • 13 Feigin VL, Norrving B, George MG, Foltz JL, Roth GA, Mensah GA. Prevention of stroke: a strategic global imperative. Nat Rev Neurol 2016; 12 (09) 501-512
    CrossrefPubMedGoogle Scholar
  • 14 Sabayan B, Isaacson R, Rost N. Opinion & special article: preventive neurology: an emerging field toward brain health. Neurology 2021; 97 (19) 916-919
    CrossrefPubMedGoogle Scholar
  • 15 Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 16 Owolabi MO, Thrift AG, Mahal A. et al; Stroke Experts Collaboration Group. Primary stroke prevention worldwide: translating evidence into action. Lancet Public Health 2022; 7 (01) e74-e85
    CrossrefPubMedGoogle Scholar
  • 17 Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res 2017; 120 (03) 472-495
    CrossrefPubMedGoogle Scholar
  • 18 Kulshreshtha A, Vaccarino V, Judd SE. et al. Life's simple 7 and risk of incident stroke: the reasons for geographic and racial differences in stroke study. Stroke 2013; 44 (07) 1909-1914
    CrossrefPubMedGoogle Scholar
  • 19 Feigin VL, Brainin M, Norrving B. et al. What is the best mix of population-wide and high-risk targeted strategies of primary stroke and cardiovascular disease prevention?. J Am Heart Assoc 2020; 9 (03) e014494
    CrossrefPubMedGoogle Scholar
  • 20 Lloyd-Jones DM, Braun LT, Ndumele CE. et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology. Circulation 2019; 139 (25) e1162-e1177
    PubMedGoogle Scholar
  • 21 Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke 1991; 22 (03) 312-318
    CrossrefPubMedGoogle Scholar
  • 22 Dufouil C, Beiser A, McLure LA. et al. Revised Framingham stroke risk profile to reflect temporal trends. Circulation 2017; 135 (12) 1145-1159
    CrossrefPubMedGoogle Scholar
  • 23 Sabayan B, Gussekloo J, de Ruijter W, Westendorp RG, de Craen AJ. Framingham stroke risk score and cognitive impairment for predicting first-time stroke in the oldest old. Stroke 2013; 44 (07) 1866-1871
    CrossrefPubMedGoogle Scholar
  • 24 Rensma SP, van Sloten TT, Launer LJ, Stehouwer CDA. Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: a systematic review and meta-analysis. Neurosci Biobehav Rev 2018; 90: 164-173
    CrossrefPubMedGoogle Scholar
  • 25 Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1: a nationwide cohort study. Thromb Haemost 2012; 107 (06) 1172-1179
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Hijazi Z, Lindbäck J, Alexander JH. et al; ARISTOTLE and STABILITY Investigators. The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation. Eur Heart J 2016; 37 (20) 1582-1590
    CrossrefPubMedGoogle Scholar
  • 27 January CT, Wann LS, Calkins H. et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019; 140 (02) e125-e151
    CrossrefPubMedGoogle Scholar
  • 28 Reshetnyak E, Ntamatungiro M, Pinheiro LC. et al. Impact of multiple social determinants of health on incident stroke. Stroke 2020; 51 (08) 2445-2453
    CrossrefPubMedGoogle Scholar
  • 29 Rosengren A, Smyth A, Rangarajan S. et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. Lancet Glob Health 2019; 7 (06) e748-e760
    CrossrefPubMedGoogle Scholar
  • 30 Davis SK, Gebreab S, Quarells R, Gibbons GH. Social determinants of cardiovascular health among black and white women residing in Stroke Belt and Buckle regions of the South. Ethn Dis 2014; 24 (02) 133-143
    PubMedGoogle Scholar
  • 31 Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. The INTERSTROKE Study: hypertension is by far the most important modifiable risk factor for stroke. Blood Press 2017; 26 (03) 131-132
    CrossrefPubMedGoogle Scholar
  • 32 O'Donnell MJ, Xavier D, Liu L. et al; INTERSTROKE Investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376 (9735): 112-123
    CrossrefPubMedGoogle Scholar
  • 33 Whelton PK, Carey RM, Aronow WS. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71 (19) e127-e248
    CrossrefPubMedGoogle Scholar
  • 34 Wright Jr JT, Williamson JD, Whelton PK. et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373 (22) 2103-2116
    CrossrefPubMedGoogle Scholar
  • 35 Lewis CE, Fine LJ, Beddhu S. et al; SPRINT Research Group. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med 2021; 384 (20) 1921-1930
    CrossrefPubMedGoogle Scholar
  • 36 Williamson JD, Pajewski NM, Auchus AP. et al; SPRINT MIND Investigators for the SPRINT Research Group. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA 2019; 321 (06) 553-561
    CrossrefPubMedGoogle Scholar
  • 37 Nasrallah IM, Pajewski NM, Auchus AP. et al; SPRINT MIND Investigators for the SPRINT Research Group. Association of intensive vs standard blood pressure control with cerebral white matter lesions. JAMA 2019; 322 (06) 524-534
    CrossrefPubMedGoogle Scholar
  • 38 Zhang W, Zhang S, Deng Y. et al; STEP Study Group. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med 2021; 385 (14) 1268-1279
    CrossrefPubMedGoogle Scholar
  • 39 Ettehad D, Emdin CA, Kiran A. et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387 (10022): 957-967
    CrossrefPubMedGoogle Scholar
  • 40 Datta BK, Ansa BE, Husain MJ. An analytical model of population level uncontrolled hypertension management: a care cascade approach. J Hum Hypertens 2022; 36 (08) 726-731
    CrossrefPubMedGoogle Scholar
  • 41 Messerli FH, Williams B, Ritz E. Essential hypertension. Lancet 2007; 370 (9587): 591-603
    CrossrefPubMedGoogle Scholar
  • 42 Turner ST, Schwartz GL, Boerwinkle E. Personalized medicine for high blood pressure. Hypertension 2007; 50 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 43 Meschia JF, Bushnell C, Boden-Albala B. et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, Council on Hypertension. 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
    CrossrefPubMedGoogle Scholar
  • 44 Naser KA, Gruber A, Thomson GA. The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster?. Int J Clin Pract 2006; 60 (09) 1093-1097
    CrossrefPubMedGoogle Scholar
  • 45 Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 2019; 15 (05) 288-298
    CrossrefPubMedGoogle Scholar
  • 46 Chen R, Ovbiagele B, Feng W. Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. Am J Med Sci 2016; 351 (04) 380-386
    CrossrefPubMedGoogle Scholar
  • 47 Janghorbani M, Hu FB, Willett WC. et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the Nurses' Health Study. Diabetes Care 2007; 30 (07) 1730-1735
    CrossrefPubMedGoogle Scholar
  • 48 Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: meta-analysis. BMJ 2012; 344: e3564
    CrossrefPubMedGoogle Scholar
  • 49 Fang HJ, Zhou YH, Tian YJ, Du HY, Sun YX, Zhong LY. Effects of intensive glucose lowering in treatment of type 2 diabetes mellitus on cardiovascular outcomes: a meta-analysis of data from 58,160 patients in 13 randomized controlled trials. Int J Cardiol 2016; 218: 50-58
    CrossrefPubMedGoogle Scholar
  • 50 van Sloten TT, Sedaghat S, Carnethon MR, Launer LJ, Stehouwer CDA. Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression. Lancet Diabetes Endocrinol 2020; 8 (04) 325-336
    CrossrefPubMedGoogle Scholar
  • 51 Xu RS. Pathogenesis of diabetic cerebral vascular disease complication. World J Diabetes 2015; 6 (01) 54-66
    CrossrefPubMedGoogle Scholar
  • 52 Endres M, Heuschmann PU, Laufs U, Hakim AM. Primary prevention of stroke: blood pressure, lipids, and heart failure. Eur Heart J 2011; 32 (05) 545-552
    CrossrefPubMedGoogle Scholar
  • 53 Sacco RL, Benson RT, Kargman DE. et al. High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study. JAMA 2001; 285 (21) 2729-2735
    CrossrefPubMedGoogle Scholar
  • 54 Vojinovic D, Kalaoja M, Trompet S. et al. Association of circulating metabolites in plasma or serum and risk of stroke: Meta-analysis from seven prospective cohorts. Neurology 2020; 96 (08) e1110-e1123
    CrossrefPubMedGoogle Scholar
  • 55 Zhou YH, Ye XF, Yu FF. et al. Lipid management in the prevention of stroke: a meta-analysis of fibrates for stroke prevention. BMC Neurol 2013; 13: 1
    CrossrefPubMedGoogle Scholar
  • 56 Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol 2009; 8 (05) 453-463
    CrossrefPubMedGoogle Scholar
  • 57 Milionis H, Ntaios G, Korompoki E, Vemmos K, Michel P. Statin-based therapy for primary and secondary prevention of ischemic stroke: a meta-analysis and critical overview. Int J Stroke 2020; 15 (04) 377-384
    CrossrefPubMedGoogle Scholar
  • 58 Jun M, Foote C, Lv J. et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet 2010; 375 (9729): 1875-1884
    CrossrefPubMedGoogle Scholar
  • 59 Lavigne PM, Karas RH. The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol 2013; 61 (04) 440-446
    CrossrefPubMedGoogle Scholar
  • 60 Sabatine MS, Giugliano RP, Keech AC. et al; FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017; 376 (18) 1713-1722
    CrossrefPubMedGoogle Scholar
  • 61 Giugliano RP, Pedersen TR, Saver JL. et al; FOURIER Investigators. Stroke prevention with the PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor evolocumab added to statin in high-risk patients with stable atherosclerosis. Stroke 2020; 51 (05) 1546-1554
    CrossrefPubMedGoogle Scholar
  • 62 Bohula EA, Wiviott SD, Giugliano RP. et al. Prevention of stroke with the addition of ezetimibe to statin therapy in patients with acute coronary syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial). Circulation 2017; 136 (25) 2440-2450
    CrossrefPubMedGoogle Scholar
  • 63 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139 (25) e1082-e1143
    CrossrefPubMedGoogle Scholar
  • 64 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief 2020; (360) 1-8
    PubMedGoogle Scholar
  • 65 Strazzullo P, D'Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke 2010; 41 (05) e418-e426
    CrossrefPubMedGoogle Scholar
  • 66 Zanella MT, Kohlmann Jr O, Ribeiro AB. Treatment of obesity hypertension and diabetes syndrome. Hypertension 2001; 38 (3, Pt 2): 705-708
    CrossrefPubMedGoogle Scholar
  • 67 Velazquez A, Apovian CM. Updates on obesity pharmacotherapy. Ann N Y Acad Sci 2018; 1411 (01) 106-119
    CrossrefPubMedGoogle Scholar
  • 68 https://www.cdc.gov/media/releases/2020/0116-americas-inactivity.html
    PubMed
  • 69 Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke 2003; 34 (10) 2475-2481
    CrossrefPubMedGoogle Scholar
  • 70 Howard VJ, McDonnell MN. Physical activity in primary stroke prevention: just do it!. Stroke 2015; 46 (06) 1735-1739
    CrossrefPubMedGoogle Scholar
  • 71 Li J, Siegrist J. Physical activity and risk of cardiovascular disease – a meta-analysis of prospective cohort studies. Int J Environ Res Public Health 2012; 9 (02) 391-407
    CrossrefPubMedGoogle Scholar
  • 72 Vicente-Campos D, Mora J, Castro-Piñero J, González-Montesinos JL, Conde-Caveda J, Chicharro JL. Impact of a physical activity program on cerebral vasoreactivity in sedentary elderly people. J Sports Med Phys Fitness 2012; 52 (05) 537-544
    PubMedGoogle Scholar
  • 73 Woods JA, Wilund KR, Martin SA, Kistler BM. Exercise, inflammation and aging. Aging Dis 2012; 3 (01) 130-140
    PubMedGoogle Scholar
  • 74 Isaacs KR, Anderson BJ, Alcantara AA, Black JE, Greenough WT. Exercise and the brain: angiogenesis in the adult rat cerebellum after vigorous physical activity and motor skill learning. J Cereb Blood Flow Metab 1992; 12 (01) 110-119
    CrossrefPubMedGoogle Scholar
  • 75 Kamada M, Kitayuguchi J, Abe T. et al. Community-wide intervention and population-level physical activity: a 5-year cluster randomized trial. Int J Epidemiol 2018; 47 (02) 642-653
    CrossrefPubMedGoogle Scholar
  • 76 Virani SS, Alonso A, Aparicio HJ. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2021 update: a report from the American Heart Association. Circulation 2021; 143 (08) e254-e743
    CrossrefPubMedGoogle Scholar
  • 77 Larsson SC, Orsini N, Wolk A. Dietary potassium intake and risk of stroke: a dose-response meta-analysis of prospective studies. Stroke 2011; 42 (10) 2746-2750
    CrossrefPubMedGoogle Scholar
  • 78 Larsson SC, Orsini N, Wolk A. Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies. Am J Clin Nutr 2012; 95 (02) 362-366
    CrossrefPubMedGoogle Scholar
  • 79 Kaluza J, Wolk A, Larsson SC. Red meat consumption and risk of stroke: a meta-analysis of prospective studies. Stroke 2012; 43 (10) 2556-2560
    CrossrefPubMedGoogle Scholar
  • 80 Feng Q, Fan S, Wu Y. et al. Adherence to the dietary approaches to stop hypertension diet and risk of stroke: a meta-analysis of prospective studies. Medicine (Baltimore) 2018; 97 (38) e12450
    CrossrefPubMedGoogle Scholar
  • 81 Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA 2012; 308 (10) 1024-1033
    CrossrefPubMedGoogle Scholar
  • 82 Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther 2010; 8 (07) 917-932
    CrossrefPubMedGoogle Scholar
  • 83 Pan B, Jin X, Jun L, Qiu S, Zheng Q, Pan M. The relationship between smoking and stroke: a meta-analysis. Medicine (Baltimore) 2019; 98 (12) e14872
    CrossrefPubMedGoogle Scholar
  • 84 Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ 2018; 360: j5855
    CrossrefPubMedGoogle Scholar
  • 85 Mazzone P, Tierney W, Hossain M, Puvenna V, Janigro D, Cucullo L. Pathophysiological impact of cigarette smoke exposure on the cerebrovascular system with a focus on the blood-brain barrier: expanding the awareness of smoking toxicity in an underappreciated area. Int J Environ Res Public Health 2010; 7 (12) 4111-4126
    CrossrefPubMedGoogle Scholar
  • 86 Duncan MS, Freiberg MS, Greevy Jr RA, Kundu S, Vasan RS, Tindle HA. Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA 2019; 322 (07) 642-650
    CrossrefPubMedGoogle Scholar
  • 87 Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis. JAMA 2003; 289 (05) 579-588
    CrossrefPubMedGoogle Scholar
  • 88 Larsson SC, Wallin A, Wolk A, Markus HS. Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Med 2016; 14 (01) 178
    CrossrefPubMedGoogle Scholar
  • 89 Day E, Rudd JHF. Alcohol use disorders and the heart. Addiction 2019; 114 (09) 1670-1678
    CrossrefPubMedGoogle Scholar
  • 90 National Institute on Alcohol Abuse and Alcoholism. Accessed October 10, 2022 at: http://www.niaaa.nih.gov
    PubMedGoogle Scholar
  • 91 The National Center for Drug Abuse Statistics. Accessed October 10, 2022 at: https://drugabusestatistics.org/
    PubMedGoogle Scholar
  • 92 de los Ríos F, Kleindorfer DO, Khoury J. et al. Trends in substance abuse preceding stroke among young adults: a population-based study. Stroke 2012; 43 (12) 3179-3183
    CrossrefPubMedGoogle Scholar
  • 93 Esse K, Fossati-Bellani M, Traylor A, Martin-Schild S. Epidemic of illicit drug use, mechanisms of action/addiction and stroke as a health hazard. Brain Behav 2011; 1 (01) 44-54
    CrossrefPubMedGoogle Scholar
  • 94 Westover AN, McBride S, Haley RW. Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients. Arch Gen Psychiatry 2007; 64 (04) 495-502
    CrossrefPubMedGoogle Scholar
  • 95 Krist AH, Davidson KW, Mangione CM. et al; US Preventive Services Task Force. Screening for unhealthy drug use: US Preventive Services Task Force Recommendation Statement. JAMA 2020; 323 (22) 2301-2309
    CrossrefPubMedGoogle Scholar
  • 96 Gallacher KI, Jani BD, Hanlon P, Nicholl BI, Mair FS. Multimorbidity in stroke. Stroke 2019; 50 (07) 1919-1926
    CrossrefPubMedGoogle Scholar
  • 97 Marini C, De Santis F, Sacco S. et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005; 36 (06) 1115-1119
    CrossrefPubMedGoogle Scholar
  • 98 George PM, Steinberg GK. Novel stroke therapeutics: unraveling stroke pathophysiology and its impact on clinical treatments. Neuron 2015; 87 (02) 297-309
    CrossrefPubMedGoogle Scholar
  • 99 McAlpine LS, Zubair AS, Maran I. et al. Ischemic stroke, inflammation, and endotheliopathy in COVID-19 patients. Stroke 2021; 52 (06) e233-e238
    CrossrefPubMedGoogle Scholar
  • 100 Libby P. The changing landscape of atherosclerosis. Nature 2021; 592 (7855): 524-533
    CrossrefPubMedGoogle Scholar
  • 101 Fyfe-Johnson AL, Muller CJ, Alonso A. et al. Heart rate variability and incident stroke: the Atherosclerosis Risk in Communities Study. Stroke 2016; 47 (06) 1452-1458
    CrossrefPubMedGoogle Scholar
  • 102 Lindsberg PJ, Grau AJ. Inflammation and infections as risk factors for ischemic stroke. Stroke 2003; 34 (10) 2518-2532
    CrossrefPubMedGoogle Scholar
  • 103 Estol CJ. Is breathing our polluted air a risk factor for stroke?. Int J Stroke 2019; 14 (04) 340-350
    CrossrefPubMedGoogle Scholar
  • 104 Miller KA, Siscovick DS, Sheppard L. et al. Long-term exposure to air pollution and incidence of cardiovascular events in women. N Engl J Med 2007; 356 (05) 447-458
    CrossrefPubMedGoogle Scholar
  • 105 Atkinson RW, Carey IM, Kent AJ, van Staa TP, Anderson HR, Cook DG. Long-term exposure to outdoor air pollution and incidence of cardiovascular diseases. Epidemiology 2013; 24 (01) 44-53
    CrossrefPubMedGoogle Scholar
  • 106 Kloog I, Coull BA, Zanobetti A, Koutrakis P, Schwartz JD. Acute and chronic effects of particles on hospital admissions in New-England. PLoS One 2012; 7 (04) e34664
    CrossrefPubMedGoogle Scholar
  • 107 Lipsett MJ, Ostro BD, Reynolds P. et al. Long-term exposure to air pollution and cardiorespiratory disease in the California teachers study cohort. Am J Respir Crit Care Med 2011; 184 (07) 828-835
    CrossrefPubMedGoogle Scholar
  • 108 Lavados PM, Olavarría VV, Hoffmeister L. Ambient temperature and stroke risk: evidence supporting a short-term effect at a population level from acute environmental exposures. Stroke 2018; 49 (01) 255-261
    CrossrefPubMedGoogle Scholar
  • 109 Watts N, Amann M, Ayeb-Karlsson S. et al. The Lancet countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 2018; 391 (10120): 581-630
    CrossrefPubMedGoogle Scholar
  • 110 South K, McCulloch L, McColl BW, Elkind MS, Allan SM, Smith CJ. Preceding infection and risk of stroke: an old concept revived by the COVID-19 pandemic. Int J Stroke 2020; 15 (07) 722-732
    CrossrefPubMedGoogle Scholar
  • 111 Merkler AE, Parikh NS, Mir S. et al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol 2020; 77 (11) 1-7
    CrossrefPubMedGoogle Scholar
  • 112 Spence JD, de Freitas GR, Pettigrew LC. et al. Mechanisms of stroke in COVID-19. Cerebrovasc Dis 2020; 49 (04) 451-458
    CrossrefPubMedGoogle Scholar
  • 113 Lee YT, Mohd Ismail NI, Wei LK. Microbiome and ischemic stroke: a systematic review. PLoS One 2021; 16 (01) e0245038
    CrossrefPubMedGoogle Scholar
  • 114 Yang T, Santisteban MM, Rodriguez V. et al. Gut dysbiosis is linked to hypertension. Hypertension 2015; 65 (06) 1331-1340
    Google Scholar
  • 115 Le Chatelier E, Nielsen T, Qin J. et al; MetaHIT Consortium. Richness of human gut microbiome correlates with metabolic markers. Nature 2013; 500 (7464): 541-546
    CrossrefPubMedGoogle Scholar
  • 116 Lupton D. Health promotion in the digital era: a critical commentary. Health Promot Int 2015; 30 (01) 174-183
    CrossrefPubMedGoogle Scholar
  • 117 Piette JD, List J, Rana GK, Townsend W, Striplin D, Heisler M. Mobile health devices as tools for worldwide cardiovascular risk reduction and disease management. Circulation 2015; 132 (21) 2012-2027
    CrossrefPubMedGoogle Scholar
  • 118 Vogt TM, Feldstein AC, Aickin M, Hu WR, Uchida AR. Electronic medical records and prevention quality: the prevention index. Am J Prev Med 2007; 33 (04) 291-296
    CrossrefPubMedGoogle Scholar
  • 119 Ambale-Venkatesh B, Yang X, Wu CO. et al. Cardiovascular event prediction by machine learning: the multi-ethnic study of atherosclerosis. Circ Res 2017; 121 (09) 1092-1101
    CrossrefPubMedGoogle Scholar
  • 120 Krishnamurthi R, Hale L, Barker-Collo S. et al. Mobile technology for primary stroke prevention. Stroke 2018 STROKEAHA118023058
    PubMedGoogle Scholar
  • 121 Yusuf S, Joseph P, Dans A. et al; International Polycap Study 3 Investigators. Polypill with or without aspirin in persons without cardiovascular disease. N Engl J Med 2021; 384 (03) 216-228
    CrossrefPubMedGoogle Scholar
  • 122 Roshandel G, Khoshnia M, Poustchi H. et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet 2019; 394 (10199): 672-683
    CrossrefPubMedGoogle Scholar
  • 123 Brainin M, Feigin V, Martins S. et al. Cut stroke in half: polypill for primary prevention in stroke. Int J Stroke 2018; 13 (06) 633-647
    CrossrefPubMedGoogle Scholar
  • 124 Muñoz D, Uzoije P, Reynolds C. et al. Polypill for cardiovascular disease prevention in an underserved population. N Engl J Med 2019; 381 (12) 1114-1123
    CrossrefPubMedGoogle Scholar
  • 125 Feinberg WM. Anticoagulation for prevention of stroke. Neurology 1998; 51 (3, Suppl 3): S20-S22
    CrossrefPubMedGoogle Scholar
  • 126 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146 (12) 857-867
    CrossrefPubMedGoogle Scholar
  • 127 Filby SJ, Dallan LAP, Cochet A. et al. Left atrial appendage occlusion using cardiac CT angiography and intracardiac echocardiography: a prospective, single-center study. J Invasive Cardiol 2021; 33 (11) E851-E856
    PubMedGoogle Scholar
  • 128 Halliday A, Harrison M, Hayter E. et al; Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 2010; 376 (9746): 1074-1084
    CrossrefPubMedGoogle Scholar
  • 129 Abbott AL, Paraskevas KI, Kakkos SK. et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke 2015; 46 (11) 3288-3301
    CrossrefPubMedGoogle Scholar
  • 130 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353 (19) 2034-2041
    CrossrefPubMedGoogle Scholar
  • 131 Guzik A, Bushnell C. Stroke epidemiology and risk factor management. Continuum (Minneap Minn) 2017; 23 (1, Cerebrovascular Disease): 15-39
    PubMedGoogle Scholar
  • 132 Spector JT, Kahn SR, Jones MR, Jayakumar M, Dalal D, Nazarian S. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 2010; 123 (07) 612-624
    CrossrefPubMedGoogle Scholar
  • 133 Øie LR, Kurth T, Gulati S, Dodick DW. Migraine and risk of stroke. J Neurol Neurosurg Psychiatry 2020; 91 (06) 593-604
    CrossrefPubMedGoogle Scholar