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Cerebrovascular disease and risk of stroke
Submitted by Dr. Yasser
Mokhtar, MD. Dept. of internal medicine. School of
medicine, University of South Dakota.
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Stroke is a loss of cerebral
function with symptoms lasting >24 hrs or death due to vascular
disease |
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3. Smoking
Although cigarette smoking has been better accepted as a risk factor for
coronary heart disease than for stroke (Fielding 1985 a-b) there is now no doubt
of an association with stroke. There is a dose response relationship, men and
women are equally affected, but the association seems to become weaker in the
elderly (Shenton and Beevers 1989). Although smoking is a strong risk factor for
SAH and for cerebral infarction, there appears to be no association with PICH (Donnan
et al., 1989). Overall, the risk attributed to cigarette smoking is greatest for
SAH, intermediate for cerebral infarction for which atherosclerotic stroke may
be most related, and lowest for cerebral hemorrhage (Longstreth et al., 1992).
4. Diabetes Mellitus
Diabetes has long been recognized as a risk factor for vascular disease in
general and it about doubles the risk of stroke compared with non-diabetics (Kannel
and McGee 1979), probably independently of any association between diabetes and
other risk factors such as hypertension (Rosengren et al., 1989 and Stout et
al., 1989).
5. Lipids
The relationship between cholesterol or lipid fractions and stroke has been
regarded as much less clear-cut than the relationship with coronary heart
disease but there almost certainly is some association (Qizilbash 1991 and
Qizilbash et al., 1992).
6. Alcohol
Some clinical studies have suggested that alcohol consumption is related to
both hemorrhagic and thromboembolic stroke (Abbott et al., 1986, Wolf et al.,
1983 and Gorelick 1987). This may be in part due to the association of alcohol
intake to cardiac abnormalities (AF and cardiomyopathy) (Lancet 1985), cigarette
smoking and the level of blood lipids (Donahue et al., 1986 and Gordon and Doyle
1986) and hypertension (because alcohol almost certainly raises blood pressure)
(Klatsky et al., 1986 and MacMahon et al., 1986).
7. Obesity
The relationship between obesity and stroke has seldom been studied.
Difficulties include inadequate number of vascular events for analysis,
measuring obesity satisfactorily, confounding by cigarette smoking because
smokers are lighter than non-smokers (Wannamethee and Shaper 1989) and the fact
that obesity is associated with (probably causal) hypertension, diabetes and
hypercholesterolemia (VanItallie 1990).
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