Don’t Get Caught Out By These “Nontraditional” Stroke Risk Factors

Some stroke risk factors are modifiable (meaning: we can do something about them); others, not so much.

So let’s do a quick rundown of the main ones:

Modifiable risk factors

• High blood pressure (hypertension): the single most important risk factor for stroke.
• Smoking: bad for everything and this is no different; smoking damages blood vessels, which significantly increases stroke risk.
• Diabetes: high blood sugars can damage blood vessels too, cumulatively over time.
• High cholesterol: commonly leads to plaque buildup in arteries (atherosclerosis), which then creates hypertension, which we mentioned up top.
• Obesity: increases the risks of hypertension and diabetes, thus indirectly increasing stroke risk.
• Physical inactivity: again increases the risks of hypertension and diabetes, thus indirectly increasing stroke risk.
• Excessive alcohol use: once again increases the risks of hypertension and diabetes, thus indirectly increasing stroke risk.
• Poor diet: increases the risk of all of the above except for smoking (yes, poor diet also increases the risk of physical inactivity, since one who does not eat well will rarely exercise well).

Non-modifiable risk factors

• Age: risk increases significantly after age 55. Technically avoidable by dying young, but we don’t recommend that.
• Sex*: men have a higher risk of having a stroke, but women are more likely to die from it. So, not easy to escape this one.
• Family history: inheritable genetic factors seem to play a part, though this is not yet well-explored (there is no established “stroke gene”, for example).
• Ethnicity: most non-white populations have an increased stroke risk compared to white people—since this is based on US data, though, it’s unclear how much of this is due to genetic factors, and how much is due to structural racism (including: disparity of generational wealth/poverty) resulting in worse medical care.
• Previous stroke or TIA (transient ischemic attack): strong predictor of future strokes. It may seem a bit of a statement of the obvious that “the kind of person who has a stroke is the kind of person who is likely to have a stroke”, but it’d be remiss to not mention it.

*Ok, since the risk factors for sex are predicted based on hormones (which affect cardiovascular disease risk and thus, indirectly, stroke risk), technically this is modifiable, but we’ll bet very few people are going to trans their gender just to get the opposite stroke risk!

So what’s this about nontraditional risk factors?

Recent research looked at over 1,000 Europeans aged 18–49, approximately half of whom (523, to be precise) had experienced a cryptogenic ischemic stroke (that’s a fancy way of saying an ischemic stroke with no clear cause).

Specifically, they looked at the following “nontraditional” risk factors:

1. Chronic multisystem disorder
2. Inflammatory bowel disease
3. Chronic kidney disease
4. Chronic liver disease
5. Autoimmune disease
6. Hematologic disease or thrombophilia
7. History of venous thrombosis
8. History of malignancy
9. Migraine with aura
10. Current illicit drug use

Even more specifically, they weighed these against having (or not having) a congenital heart defect, a patent foramen ovale (PFO), colloquially called a “hole in the heart“. They found:

• Nontraditional risks had the strongest association with stroke in people with a PFO.
• Nevertheless, for those without a PFO, each nontraditional factor increased stroke risk by 70%, compared to a 41% increase per traditional risk factor.
• Female-centric risks outside of hormones (e.g. pregnancy complications, gestational diabetes) raised stroke risk by 70%, independently of other factors.
• Migraine with aura was the top nontraditional risk, accounting for 46% of strokes in PFO patients and 23% in those without.

You can read the paper itself here: Burden of Modifiable Risk Factors in Young-Onset Cryptogenic Ischemic Stroke by High-Risk Patent Foramen Ovale

Since migraines themselves are much-misunderstood, you might want to check out:

Migraine Mythbusting ← which also includes resources for managing this condition

Chronic kidney disease was also a top contender for increasing stroke risk, so check out:

Are your Kidneys Ok? Detect Early To Protect Kidney Health (Here’s How)

…and also:

Keeping Your Kidneys Healthy (Especially After 60) ← it’s about a lot more than just hydration!

Want to learn more?

Check out:

Reduce Your Stroke Risk

Take care!