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Acute stroke is the third leading cause of death in the United States behind cardiovascular disease and cancer. Approximately 700,000 people in the U.S. experience a new or recurrent stroke each year, and approximately 150,000 annual deaths are attributed to strokes. Additionally, acute stroke is the primary cause of long-term disability in the U.S.; of the estimated 5.5 million American stroke survivors, over one million have stroke-related functional difficulties.

From 1994 to 2004, the mortality rate from acute strokes declined by 20 percent. This decline is primarily attributed to early recognition of symptoms, rapid emergency medical response systems and improved stroke prehospital care, as well as more collaborative protocols for stroke hospital management. However, heightened awareness of the common risk factors has also contributed to the declining death rate, with more and more Americans becoming aware of the behavioral, medical and heritable factors that contribute to heightened incidence of acute stroke.

Behavioral Risk Factors for Stroke

Many key risk factors for acute stroke are controllable and result from a person's lifestyle. Unlike medical or biological risk factors, those resulting from lifestyle or environment can be modified with the help of a healthcare professional. For example:

• Smoking: Cigarette smoke damages the cardiovascular system through nicotine and carbon monoxide, and has been identified as an important risk factor for stroke. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
• Obesity: Obesity is a primary contributor to a variety of medical risks, including high blood pressure, high cholesterol, diabetes and heart disease—all of which are accompanied by heightened risk of stroke. 
• Physical inactivity: Combined with an unhealthy diet, physical inactivity often leads to obesity, another key risk factor for stroke.
• Heavy alcohol usage: Alcohol abuse can lead to multiple medical complications, including other significant medical risk factors for stroke.

Medical Risk Factors for Stroke

Other key risk factors for acute stroke result from medical conditions or resulting complications from medical conditions. Many of these stroke risk factors can be controlled or mitigated through proper treatment. For example:

• High blood pressure: Stroke risk rises as blood pressure rises, and risk decreases as blood pressure readings decrease. Patients with high blood pressure controlled through medication have less risk than patients whose hypertension is poorly controlled.
• History of cardiovascular disease: A major risk factor for stroke, heart disease can result from uncontrollable factors like age, gender and ethnicity, but also controllable behaviors like smoking, physical inactivity or high cholesterol.
• Atrial fibrillation: This heart rhythm disorder raises the risk for stroke through higher likelihood of blood pooling and clotting. Clots may break off, enter the bloodstream and lodge in an artery leading to the brain, resulting in a stroke.
• Diabetes mellitus: Diabetes mellitus is treatable, although the presence alone of the disease increases risk of stroke. Many people with diabetes also have high blood pressure, high cholesterol and are overweight, further increasing the risk of health complications, including stroke.
• Previous stroke or blockage of circulation to the brain: Patients that have already suffered a stroke are at significantly higher stroke risk than patients who have never had a stroke.
• High cholesterol: The prevalence of cardiovascular disease, a key risk factor for stroke, rises as blood cholesterol levels increase. When other risk factors such as high blood pressure and tobacco smoke are present, stroke risk increases.

Biological Risk Factors for Stroke

Biological factors contributing to heightened risk of acute stroke are generally out of one’s control. However, adults should be cognizant of these biologically-rooted risk factors and weigh them against relevant behavioral and medical risk factors in determining stroke risk. For example:

• Family history: Stroke risk is greater in people who have a family history of stroke.
• Age: Patients age 55 and over have twice the risk of suffering a stroke than someone under the age of 55.
• Ethnicity: Some ethnic groups, including Native Americans, Hispanic Americans and African Americans, have increased risk of stroke.
• Gender: The incidence of stroke in men is greater than that of women until the age of 80, when the incidence of stroke in women exceeds that of men.

To learn more about stroke risk factors, as well as treatment strategies, such as the advanced cardiac life support (ACLS) stroke algorithm, consider taking an ACLS certification training course and learning more about stroke certification requirements, which Health Ed Solutions offers.

The information included in this article is based on the 2020 guidelines for CPR, first aid and advanced cardiovascular care.