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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.

 

Stroke is a loss of cerebral function with symptoms lasting >24 hrs or death due to vascular disease

 
 

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8. Oral contraceptive use

Despite many studies, the role of contraceptives in stroke and in particular thromboembolic still remains controversial (Longstreth and Swanson 1984). Unless a user of oral contraceptives is also a cigarette smoker and over the age of thirty years, the absolute risk of a serious vascular event is so low that there is no great cause for concern (Croft and Hannaford 1989).

9. Transient ischemic attacks

Because TIAs are, in a sense, ischemic strokes that happen to recover within twenty four hours, it is not surprising that they are a risk for stroke. Having experienced a TIA, the risk of subsequent infarction is greatest within the first month. About thirty six per cent of infarctions will occur within the first month following a TIA and fifty per cent by the end of the first year, thereafter the risk becomes much less (Toole 1984).

10. Blood viscosity

Blood flow in any given vessel is inversely proportional to the viscosity of the blood flowing through it, as governed by Poiseuille?s law (Dintenfass et al., 1985). The whole blood viscosity is largely influenced by hematocrit and plasma viscosity, which in turn is largely influenced by the presence of macromolecules such as fibrinogen. Data from the Framingham (Kannel et al., 1972) and other studies (Wihelmsen 1984 and D?Agostino 1985) have shown both elevated hematocrits and fibrinogen levels to be related to an increased risk of stroke. Further studies showed that any effect of increasing hematocrit on risk of stroke is weak and confounded by cigarette smoking, blood pressure and plasma fibrinogen (LaRue et al., 1987). There is a strong and consistent relationship between plasma fibrinogen and stroke. The association is attenuated by cigarette smoking and other confounding variables (Cook and Ubben 1990, Rosengren et al., 1990 and Qizilbash et al., 1991).

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