Abstract
Ischemic strokes account for 87% of all strokes in the US. Patients who suffer an
initial ischemic stroke or transient ischemic attack are at risk for recurrent strokes,
as well as ischemic events in the coronary and peripheral vasculatures. Lifestyle
modifications and pharmacological and surgical interventions are effective in reducing
the risk of recurrent events in all stroke patients, and evidence-based guidelines
for secondary stroke prevention are available. However, increasing evidence indicates
that risk factors may be differentially associated with specific ischemic stroke subtypes.
In the future, exploiting these differential associations may facilitate secondary
stroke prevention and, therefore, improve patient outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics 2008 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation. 2008; 117: e25-e146
- The influence of gender and age on disability following ischemic stroke: the Framingham study.J Stroke Cerebrovasc Dis. 2003; 12: 119-126
- Rate, degree, and predictors of recovery from disability following ischemic stroke.Neurology. 2007; 68: 1583-1587
- Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study.Stroke. 2004; 35: 731-735
- One-year cardiovascular event rates in outpatients with atherothrombosis.JAMA. 2007; 297: 1197-1206
- Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack.Stroke. 2008; 39: 1647-1652
- Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline.Stroke. 2006; 37: 577-617
- Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).Chest. 2008; 133: 630S-669S
- Risk factors for ischemic stroke subtypes: the Atherosclerosis Risk in Communities study.Stroke. 2006; 37: 2493-2498
- Ischemic stroke subtypes: a population-based study of incidence and risk factors.Stroke. 1999; 30: 2513-2516
- Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies.Stroke. 2003; 34: 2050-2059
- Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts.Stroke. 2005; 36: 891-901
- Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank.Stroke. 2001; 32: 2559-2566
- Proportions of stroke subtypes among men and women>or=40 years of age in an urban Japanese city in 1992, 1997, and 2002.Stroke. 2006; 37: 1374-1378
- Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study.Stroke. 2001; 32: 2735-2740
- Mechanisms of recurrence in subtypes of ischemic stroke: a hospital-based follow-up study.Arch Neurol. 2005; 62: 1232-1237
- Ischemic stroke subtypes among Mexican Americans and non-Hispanic whites: the BASIC Project.Neurology. 2004; 63: 574-576
- Ischemic stroke subtypes: a population-based study of functional outcome, survival, and recurrence.Stroke. 2000; 31: 1062-1068
- Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies.Neurology. 2004; 62: 569-573
- Risk factors for early recurrence after ischemic stroke: the role of stroke syndrome and subtype.Stroke. 1998; 29: 2118-2124
- Risk factors and subtype analysis of acute ischemic stroke.Eur Neurol. 2008; 60: 230-236
- Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups.Neurology. 2004; 63: 1868-1875
- Infection and risk of ischemic stroke: differences among stroke subtypes.Stroke. 2003; 34: 452-457
- Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project.J Neurol Sci. 2006; 244: 143-150
- Ischemic stroke subtypes: risk factors, functional outcome and recurrence.Neurol Sci. 2002; 22: 449-454
- Short- and long-term effects of smoking on arterial wall properties in habitual smokers.J Am Coll Cardiol. 1993; 22: 1881-1886
- Determinants of plasma fibrinogen: relation to body weight, waist-to-hip ratio, smoking, alcohol, age, and sex. Results from the second MONICA Augsburg survey 1989–1990.Arterioscler Thromb. 1992; 12: 780-788
- Alcohol consumption and risk of stroke: a meta-analysis.JAMA. 2003; 289: 579-588
- Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants.Stroke. 1999; 30: 2535-2540
- Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study.Stroke. 2003; 34: 1586-1592
- Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.Arch Intern Med. 2002; 162: 1867-1872
- Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies.Neurology. 2005; 65: 1193-1197
- Statins and the stroke-cholesterol paradox.Neth J Med. 2002; 60: 4-9
- Lipids in ischemic stroke subtypes.Acta Neurol Belg. 2004; 104: 13-19
- Different risk factor profiles between subtypes of ischemic stroke. A case-control study in Korean men.Eur J Epidemiol. 2005; 20: 605-612
- Acute phase proteins and oxidised low-density lipoprotein in association with ischemic stroke subtype, severity and outcome.Free Radic Res. 2007; 41: 282-287
- Lp(a) lipoprotein and plasminogen activity in patients with different etiology of ischemic stroke.Cerebrovasc Dis. 2007; 23: 188-193
- Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20,536 people with cerebrovascular disease or other high-risk conditions.Lancet. 2004; 363: 757-767
- Reduction of stroke incidence after myocardial infarction with pravastatin: the Cholesterol and Recurrent Events (CARE) study. The Care Investigators.Circulation. 1999; 99: 216-223
- Effects of atorvastatin on stroke in patients with unstable angina or non-Q-wave myocardial infarction: a Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) substudy.Circulation. 2002; 106: 1690-1695
- High-dose atorvastatin after stroke or transient ischemic attack.N Engl J Med. 2006; 355: 549-559
- Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy: an invited review.Stroke. 2002; 33: 862-875
- Effects of statins on stroke prevention in patients with and without coronary heart disease: a meta-analysis of randomized controlled trials.Am J Med. 2004; 117: 596-606
- Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials.Arch Intern Med. 2003; 163: 669-676
- Clinical characteristics of first-ever atherothrombotic infarction or lacunar infarction with hyperlipidemia (J-STARS-C): an analysis of data from the stroke data bank of Japan.Intern Med. 2005; 44: 1252-1257
- Blood pressure reduction and secondary prevention of stroke and other vascular events: a systematic review.Stroke. 2003; 34: 2741-2748
- Secondary Prevention of Small Subcortical Strokes. May 9, 2007 (Available from: www.sps3.org. Cited December 19, 2007)
- Long-term risk of first recurrent stroke in the Perth community stroke study.Stroke. 1998; 29: 2491-2500
- Characteristics and six-month outcomes in a cohort of 8288 diabetic and non-diabetic patients with previous history of acute coronary syndrome or stroke: the French PREVENIR 3 survey.Diabetes Metab. 2006; 32: 460-466
- Effect of a multifactorial intervention on mortality in type 2 diabetes.N Engl J Med. 2008; 358: 580-591
National Heart, Lung and Blood Institute. For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in Clinical Trial of Diabetes and Cardiovascular Disease. NIH News. February 6, 2008. Available from: http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2551. Cited February 15, 2008.
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke. 1993; 24: 35-41
- Precipitants of brain infarction. Roles of preceding infection/inflammation and recent psychological stress.Stroke. 1996; 27: 1999-2004
- Helicobacter pylori infection as an independent risk factor for cerebral ischemia of atherothrombotic origin.J Neurol Sci. 2001; 186: 1-5
- Association between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes: results from a population-based case-control study.Stroke. 2001; 32: 2253-2258
- Inflammation and infections as risk factors for ischemic stroke.Stroke. 2003; 34: 2518-2532
- Association between high homocyst(e)ine and ischemic stroke due to large- and small-artery disease but not other etiologic subtypes of ischemic stroke.Stroke. 2000; 31: 1069-1075
- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.BMJ. 2002; 324: 71-86
- A randomized trial of aspirin and sulfinpyrazone in threatened stroke.N Engl J Med. 1978; 299: 53-59
- The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results.J Neurol Neurosurg Psychiatry. 1991; 54: 1044-1054
- European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke.J Neurol Sci. 1996; 143: 1-13
- Aspirin and Extended-Release Dipyridamole versus Clopidogrel for recurrent stroke.N Engl J Med. 2008; 359: 1238-1251
- Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial.Lancet. 2006; 367: 1665-1673
- A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE).Lancet. 1996; 348: 1329-1339
- Dipyridamole for preventing stroke and other vascular events in patients with vascular disease.Cochrane Database Syst Rev. 2006; ([CD001820])
- Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.N Engl J Med. 2001; 345: 494-502
- Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.Lancet. 2001; 358: 527-533
- Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial.JAMA. 2002; 288: 2411-2420
- Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation.N Engl J Med. 2005; 352: 1179-1189
- Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial.Lancet. 2005; 366: 1607-1621
- 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: 331-337
- Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events.N Engl J Med. 2006; 354: 1706-1717
- Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial.J Am Coll Cardiol. 2007; 49: 1982-1988
- Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial.Lancet Neurol. 2007; 6: 961-969
- Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial.Lancet. 2006; 367: 1903-1912
- Clopidogrel and aspirin versus aspirin alone for the prevention of stroke in patients with a history of atrial fibrillation: subgroup analysis of the CHARISMA randomized trial.Cerebrovasc Dis. 2008; 25: 344-347
- A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke.N Engl J Med. 2001; 345: 1444-1451
- Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke.JAMA. 2004; 291: 576-584
- Atrial anatomy in non-cardioembolic stroke patients: effect of medical therapy.J Am Coll Cardiol. 2003; 42: 1066-1072
- Antiplatelet drugs in the secondary prevention after stroke: differential efficacy in large versus small vessel disease? A subgroup analysis from ESPS-2.Stroke. 2006; 37: 134-138
- Implications of stroke prevention trials: treatment of global risk.Neurology. 2005; 65: 17-21
- PROTECT: a coordinated stroke treatment program to prevent recurrent thromboembolic events.Neurology. 2004; 63: 1217-1222
- In-hospital initiation of secondary stroke prevention therapies yields high rates of adherence at follow-up.Stroke. 2004; 35: 2879-2883
- The American Heart Association Get With The Guidelines program.Am Heart J. 2004; 148: S46-S48
- New study targets long-term stroke prevention adherence. May 31, 2006 (Available from: http://www.medicalnewstoday.com/medicalnews.php?newsid=44252. Cited May 22, 2007)
- Subtypes of ischemic stroke. A hospital-based stroke registry in Taiwan (SCAN-IV).Stroke. 1997; 28: 2507-2512
Article info
Publication history
Published online: January 30, 2009
Accepted:
December 15,
2008
Received in revised form:
December 11,
2008
Received:
September 19,
2008
Identification
Copyright
© 2008 Elsevier B.V. Published by Elsevier Inc. All rights reserved.