The risk factors for cerebral ischemia can be classified as modifiable and non-modifiable. The presence of two or more risk factors substantially increases the likelihood of experiencing a cerebral ischemia.
Cerebrovascular disease is the leading cause of neurological hospitalization worldwide.
This common disease is due to the prevalence of chronic conditions such as hypertension, diabetes mellitus, dyslipidemia, smoking, and increased life expectancy, all considered risk factors. Approximately 80% of strokes are ischemic, resulting from acute arterial occlusion in a specific vascular territory; the remaining 20% correspond to the hemorrhagic variant. The neurological sequelae secondary to this condition are the leading cause of chronic disability in patients and are associated with high morbidity and mortality.
The best approach is to prevent cerebral ischemia by maintaining a healthy lifestyle.
Most Important Non-Modifiable Risk Factors for Cerebral Ischemia
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Age:
The risk of cerebral ischemia increases significantly with age, especially after the age of 55. -
Sex:
Men generally have a higher risk of experiencing a cerebral ischemia at a younger age, although women tend to have a higher overall lifetime risk due to longer life expectancy. -
Family history (genetics):
A family history of stroke or cardiovascular disease increases the risk, suggesting a genetic predisposition to vascular conditions. -
Race and ethnicity:
Certain populations—such as African Americans, Hispanics, and South Asians—have a higher risk due to a greater prevalence of hypertension, diabetes, and other contributing conditions. -
History of prior stroke or transient ischemic attack (TIA):
Individuals who have experienced a stroke or TIA in the past are at greater risk of having another cerebral ischemic event.
Modifiable Risk Factors for Cerebral Ischemia
Elevated arterial hypertension (HTN)
The most important modifiable risk factor is arterial hypertension, as it promotes the formation of atherosclerotic lesions.
The changes that occur in the arterial wall due to prolonged excessive blood pressure hinder the flow of blood through it, making it difficult for oxygen to reach the tissues.
For this reason, strict blood pressure control is considered highly important in the short, medium, and long term, even at very advanced ages.
Controlling blood pressure levels often requires the use of medication, but certain lifestyle-related measures can be very helpful: proper exercise, a healthy diet, and avoiding excess weight.
Diabetes mellitus
An increase in circulating blood glucose promotes changes in the arterial wall. Therefore, controlling blood glucose levels in patients with diabetes is essential to prevent the onset of ischemic heart disease at all ages.
It is becoming a major risk factor, increasingly common and with a particular impact on women.
Once again, its onset is linked to dietary excess and an increasingly sedentary lifestyle. Its treatment clearly includes pharmacological measures, but once more, lifestyle changes are of crucial importance.
Diabetes mellitus directly impacts factors such as:
- Increased susceptibility to atherosclerosis:
Hyperglycemia induces protein glycosylation, which can accelerate atherogenesis. - Increase in pro-atherogenic factors:
-Decreased fibrinolytic activity
-Increased platelet aggregation and adhesion
-Elevated levels of fibrinogen and factors VII and VIII
-Increased viscosity
-Aumento de la disfunción endotelial
Patients with diabetes have a 2 to 3 times higher risk of ischemia and a 1.56 times greater risk of experiencing a cerebral hemorrhage compared to the general population.
Various studies show that diabetes mellitus increases the likelihood of cerebrovascular recurrence by 2 to 5 times. Diabetes mellitus also increases the risk of progression and triples the likelihood of developing dementia after a stroke.
Dyslipidemia
Dyslipidemia is an important risk factor for coronary heart disease; however, the relationship between serum cholesterol levels and the incidence of stroke is not entirely clear. While cholesterol is an established risk factor for atherosclerosis, the degree of risk varies depending on the subtypes of ischemia.
Studies examining types of ischemic stroke have documented a weak but positive association between elevated cholesterol and ischemic stroke, particularly in the large-artery atherosclerotic subtypes and lacunar infarcts.
It is important to remember the strong association between hypercholesterolemia and carotid atherosclerosis.
The deposition of these components in the arterial wall also leads to the gradual narrowing of the artery, in the same way as high blood pressure or the changes caused by poorly controlled diabetes. Therefore, following a healthy diet low in saturated fats and refined sugars is of great importance in the prevention of ischemic stroke.
Smoking
Smoking plays a significant role in all subtypes of cerebrovascular disease, as it leads to increased fibrinogen levels and platelet adhesiveness, while also promoting the development of atherosclerosis, vascular constriction, and polycythemia.
The habit of smoking increases the risk of developing ischemic heart disease and is considered to counteract the effectiveness of treatments for this condition.
Therefore, complete cessation of smoking, even at advanced ages, results in a reduction in the occurrence of ischemic heart disease in patients of all ages.
Atrial fibrillation
In patients with atrial fibrillation, the most serious complication is arterial thromboembolism, with stroke being the most evident clinical manifestation. However, the risk of stroke in individuals with atrial fibrillation is closely related to other variables.
Atrial fibrillation is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart. During atrial fibrillation, the upper chambers (atria) of the heart beat chaotically and irregularly, out of sync with the lower chambers (ventricles) of the heart.
Treatment for atrial fibrillation may include medications, therapy to restore heart rhythm, and catheter-based procedures to block faulty cardiac signals.
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