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What are the risk factors for stroke?

Age is the single most important risk factor for stroke overall. Stroke rates steadily increase after age 55. There is also a likely genetic component to stroke, which is an area of active research. The good news is that there are many known modifiable stroke risk factors. The most important one is hypertension (high blood pressure). Others include diabetes, atrial fibrillation, carotid artery disease, high cholesterol, obesity, physical inactivity and excessive alcohol use.

The risk factors for stroke are cumulative, so reducing even one will lower your overall risk for stroke.

  • Age: The chance of having a stroke approximately doubles for each decade of life after age 55. In addition, researchers have noted a surge in strokes among women between 40 and 55 that can be tied to metabolic risk factors including increased abdominal weight and diabetes. There are also certain risk factors that apply directly to women under 55.
  • Family history: If a parent, grandparent, sister or brother has had a stroke, you are at increased risk for having one too.
  • Ethnic background: According to the National Stroke Association, blacks experience stroke earlier in their lives and are twice as likely to die from stroke than are whites. Hispanics and Native Americans also have increased risk for stroke. For these groups, higher rates of stroke risk factors such as high blood pressure, diabetes and obesity may be responsible for higher rates of stroke.
  • Prior stroke or transient ischemic attack (TIA) is another stroke risk factor.
  • High blood pressure: High blood pressure is the leading cause of stroke and the most important controllable risk factor.
  • Heart disease or prior heart attack: Heart disease, including arterial disease, coronary heart disease, heart failure and atrial fibrillation, can contribute to an increased risk for stroke.
  • Persistent symptoms, such as shortness of breath, nausea, great fatigue, angina/chest pain, fainting spells and gas-like discomfort, are red flags.
  • Smoking: Cigarette smoking on its own is a significant risk factor for stroke. When oral contraceptives are used in combination with cigarette smoking, stroke risk is greatly increased.
  • Poor diet: Diets high in saturated fats, trans fats, cholesterol and/or sodium can increase stroke risk. In contrast, a diet containing five or more servings of fruits and vegetables per day may reduce risk.
  • Diabetes, drug or alcohol abuse, high cholesterol, obesity, physical inactivity and sickle cell anemia all can increase risk for stroke.

Besides high blood pressure, other risk factors for strokes include:

  • smoking
  • high cholesterol 
  • obesity

The good news is, if you are able to stop smoking, lower your blood pressure and maintain a healthy weight you will reduce your risk for strokes, while also lowering your risk for a heart attack.

Among the factors that increase the risk of stroke, some are out of our control. Those we inherit from our parents are beyond our control. Others can be controlled by making healthy lifestyle choices and working with your doctor. 

Risk factors you cannot control 

  • Family history. If your family members had a stroke, your risk of having one is higher. 
  • Race. If you are of African American heritage, you are at higher risk of stroke than someone of Caucasian descent. 
  • Gender. Men are more likely to have a stroke than women, but women account for more deaths due to stroke than men. 
  • Age. The older you are, the higher your risk for stroke. A previous stroke, TIA or heart attack. Your chance of stroke is higher if you had one or if you have had a heart attack. 

Risk factors you can control or treat 

  • High blood pressure. Medical science points to high blood pressure as most important risk factor we can control to lower the risk of stroke. 
  • Cigarette smoking. Giving up tobacco helps lower the risk of stroke. Studies found the combination of oral contraceptives and smoking greatly increases the risk of stroke. 
  • Diabetes. Diabetes contributes to the risk for stroke. 
  • High cholesterol. People with high blood cholesterol have an increased risk for stroke. Having a low HDL cholesterol level has been identified as a risk factor for stroke in men. More data is needed to determine its impact on the risk of stroke in women. 
  • Diet. Eating foods that contribute to high blood pressure, high cholesterol and overweight increases the risk of stroke. 
  • Physical inactivity. Not getting regular exercise can contribute to high blood pressure, high cholesterol and diabetes and heart disease, all risk factors for stroke. 
  • Disease of the arteries. A build-up of plaque inside the walls of your arteries, in your heart, your legs and especially in the carotid arteries in the neck-carry blood to the brain, can increase the risk of stroke. Heart disease. The presence of heart disease and atrial fibrillation (AF) raises the risk of stroke. In AF, because the heartbeat is fast and irregular, blood can pool and clot in the heart. This raises the risk that a clot will break loose, travel to the brain and cause a stroke. 
  • Sickle cell disease. People with sickle cell disease, which is inherited, are at higher risk for stroke.

Anyone can have a stroke. But studies show that you are more likely to have a stroke if you have these risk factors:

  • High blood pressure
  • Cholesterol problems (high low-density lipoprotein [LDL] or triglycerides, or low high-density lipoprotein [HDL])
  • Diabetes
  • Smoking
  • Atrial fibrillation or other heart disease
  • Atherosclerosis (fatty buildup in your arteries)
  • Obesity
  • Physical inactivity
  • Drug or alcohol abuse
  • Use of birth control pills (greater risk if you're over age 35 or if you smoke)
  • Ethnicity (African Americans and Hispanics have a higher risk)
  • Family or medical history of stroke or transient ischemic attack (TIA) (you or someone in your family has had a stroke or TIA in the past)
  • Age (the older you are, the higher your risk)

Risk factors for stroke include:

  • Age. The risk of stroke increases with each decade of life.
  • Family history. Having a close relative with heart disease or a history of stroke increases stroke risk.
  • Ethnicity. African-American women have a greater risk of having a stroke, and of dying from one, than white women.
  • A previous stroke or transient ischemic attack (TIA). Women who have a stroke between ages 40 and 69 have a 22 percent chance of having another within five years of the first. Women who have a TIA are also at greater risk of stroke.
  • High blood pressure. Hypertension, which is linked to ruptured blood vessels, is the most important risk factor for hemorrhagic stroke as well as a major contributor to strokes caused by blood clots.
  • Smoking. Women who smoke have an increased risk of stroke, which climbs even higher if they use oral contraceptives.
  • Unfavorable cholesterol profile. Low HDL cholesterol levels (below 40 mg/dL) are a stronger risk factor for women than for men.
  • Physical inactivity. Lack of exercise, which is directly linked to an increased risk of heart disease, contributes to obesity and other risk factors for stroke.
  • Obesity and overweight. Being overweight increases stroke risk as well as risk for heart disease.

The odds of having a stroke more than double every 10 years after age 55. More than two-thirds of strokes involve people over 65. If you have a stroke, the risk of dying from it also increases with age: 88 percent of deaths from stroke are in people 65 and older.

Women have about 55,000 more strokes than men each year, and women make up about 60 percent of stroke deaths. Race is another risk factor. African Americans, for example, are almost twice as likely to suffer a stroke as are whites.

Although you can't change your age, gender or race, you can take steps to reduce other risk factors for stroke, especially ischemic stroke, which results from an interruption in blood flow through an artery supplying a specific area of the brain. The most common risk factors for both ischemic stroke and transient ischemic attacks (TIAs) are high blood pressure (hypertension), diabetes, unhealthy cholesterol levels, obesity and cigarette smoking. All of these factors affect the health of your blood vessels—increasing the risk not only of stroke, but also of heart disease. That's why medications and other steps you take to reduce the risk of an ischemic stroke will also benefit your heart.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

The risk factors for stroke are:

  • High blood pressure (hypertension) puts vessels under undue pressure, damaging their integrity and making them more prone to clots, hardening or rupture.
  • Diabetes doubles the risk factor for stroke because people with diabetes tend have the conventional cluster of risk factors that increase risk for heart disease—large waist circumference, obesity, abnormal cholesterol and hypertension—and high sugar and possibly insulin resistance, where insulin produced by the body becomes less effective in transporting glucose in and out of cells, may be additional risk factors that stand on their own.
  • Atrial fibrillation, a type of heart rhythm disorder, is conducive to making clots that can travel throughout the bloodstream and up to the brain.
  • Carotid stenosis is the narrowing and hardening (atherosclerosis) of the carotid arteries in the neck, the blood's main highway to the brain.
  • Smoking tobacco
  • High LDL blood cholesterol (hypercholesterolemia)
  • Prior stroke or Transient ischemic attacks (a third of people who have a TIA will go on to have a stroke in the future)
  • Alcohol and drug use (particularly cocaine, amphetamines, heroin)
  • Certain medications such as blood thinners (for hemorrhagic stroke) and hormone replacement therapy and oral contraceptives
  • Diets low in fruit and vegetables and high in salt and fat
  • Sedentary lifestyle
  • Central obesity (waist circumference larger than 35 for women and 40 for men)
  • Family history of stroke

This content originally appeared on doctoroz.com

Dr. Jeffrey L. Saver, MD
Neurologist

The risk factors for stroke are behaviors or medical conditions that cause fatty plaque to build up in blood vessels, increase the clotting tendency of the blood or cause clots to form in and break off from the heart. The leading treatable risk factors are high blood pressure, high cholesterol levels, smoking, excessive alcohol use, physical inactivity, diabetes and the abnormal heart rhythm of atrial fibrillation. By treating these risk factors, the risk of stroke can be reduced by more than 75 percent.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.