Özet
Modifiable risk factors constitute approximately 90% of the cumulative risk factor burden in the setting of stroke, and 9 out of 10 strokes are preventable by optimization of these vascular risk factors. The present study investigated the relationship between risk factor control, stroke preventability and stroke subtypes. A total of 787 acute ischemic stroke patients were included into the study; their demographic data, together with clinical and laboratory parameters related to vascular risk factors were collected. Stroke subtypes were defined according to the Causative Classification System of Stroke (CCS). In this cohort, the distributionof stroke subtypes was as follows: 30% large artery atherosclerosis (LAA), 25.8% cardioembolism (CE), 11.4% small artery occlusion (SAO), 6.2% other causes, 23,4% cryptogenic and 3.2% unclassified causes. In regard of risk factors, 36.8% of patients had diabetes mellitus (DM), 69.9% had hypertension (HT), 28.6% had hyperlipidemia (HL), 12.6% had known and an additional 11.4% had new diagnosis of atrial fibrillation (AF), 37.6% had other cardiovascular diseases and 20.3% had history of previous stroke. SAO subtypes revealed worse control in terms of DM, HL, HT, diet and physical activity profiles compared to other groups. SAO and cryptogenic subtypes experienced the events despite appropriate antitrombotic therapy and had greater number of sub-optimally controlled risk factors. Long term randomized controlled studies with larger populations are needed to confirm our observations and adjust the treatment perspectives especially in patients with cryptogenic stroke and SAO.
Künye
KAYNAKLAR
1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2013;44:2064-2089
2. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the interstroke study): A case-control study. Lancet (London, England). 2010;376:112-123
3. Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, et al. Factors influencing the decline in stroke mortality: A statement from the american heart association/american stroke association. Stroke. 2014;45:315-353
4. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2014;45:2160-2236
5. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet (London, England). 1991;337:1521-1526
6. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: A systematic review and meta-analysis. Lancet Neurol. 2007;6:1063-1072
7. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 acc/aha/aapa/abc/acpm/ags/apha/ash/aspc/nma/pcna guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Journal of the American College of Cardiology. 2018;71:2199-2269
8. Katsanos AH, Filippatou A, Manios E, Deftereos S, Parissis J, Frogoudaki A, et al. Blood pressure reduction and secondary stroke prevention: A systematic review and metaregression analysis of randomized clinical trials. Hypertension (Dallas, Tex. : 1979). 2017;69:171-179
9. Lovett JK, Coull AJ, Rothwell PM. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology. 2004;62:569-573
10. Dhamoon MS, Tai W, Boden-Albala B, Rundek T, Paik MC, Sacco RL, et al. Risk of myocardial infarction or vascular death after first ischemic stroke: The northern manhattan study. Stroke. 2007;38:1752-1758
11. Kaplan RC, Tirschwell DL, Longstreth WT, Jr., Manolio TA, Heckbert SR, Lefkowitz D, et al. Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology. 2005;65:835-842
12. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet (London, England). 2002;360:1903-1913
13. Lawes CM, Bennett DA, Feigin VL, Rodgers A. Blood pressure and stroke: An overview of published reviews. Stroke. 2004;35:1024
14. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ (Clinical research ed.). 2009;338:b1665
15. Post-stroke antihypertensive treatment study. A preliminary result. Chinese medical journal. 1995;108:710-717
16. Castilla-Guerra L, Fernandez-Moreno Mdel C. Update on the management of hypertension for secondary stroke prevention. Eur Neurol. 2012;68:1-7
17. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet (London, England). 2001;358:1033-1041
18. Arima H, Chalmers J, Woodward M, Anderson C, Rodgers A, Davis S, et al. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: The progress trial. Journal of hypertension. 2006;24:1201-1208
19. Schrader J, Luders S, Kulschewski A, Hammersen F, Plate K, Berger J, et al. Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention: Principal results of a prospective randomized controlled study (moses). Stroke. 2005;36:1218-1226
20. Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2013;44:870-947
21. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2018;49:e46-e110
22. Guzik A, Bushnell C. Stroke epidemiology and risk factor management. Continuum (Minneapolis, Minn.). 2017;23:15-39
23. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. Dash collaborative research group. N Engl J Med. 1997;336:1117-1124
24. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a mediterranean diet. N Engl J Med. 2013;368:1279-1290
25. Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: A high-risk state for diabetes development. Lancet (London, England). 2012;379:2279-2290
26. Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: From pathophysiology to prevention and management. Lancet (London, England). 2011;378:169-181
27. Kernan WN, Inzucchi SE, Sawan C, Macko RF, Furie KL. Obesity: A stubbornly obvious target for stroke prevention. Stroke. 2013;44:278-286
28. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The atherosclerosis risk in communities (aric) study investigators. Diabetes care. 1999;22:1077-1083
29. Thacker EL, Psaty BM, McKnight B, Heckbert SR, Longstreth WT, Jr., Mukamal KJ, et al. Fasting and post-glucose load measures of insulin resistance and risk of ischemic stroke in older adults. Stroke. 2011;42:3347-3351
30. Standards of medical care in diabetes--2013. Diabetes care. 2013;36 Suppl 1:S11-66
31. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42:517-584
32. Hyvarinen M, Tuomilehto J, Mahonen M, Stehouwer CD, Pyorala K, Zethelius B, et al. Hyperglycemia and incidence of ischemic and hemorrhagic stroke-comparison between fasting and 2-hour glucose criteria. Stroke. 2009;40:1633-1637
33. Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: Meta-analysis. BMJ (Clinical research ed.). 2012;344:e3564
34. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010;362:800-811
35. Gray CS, Scott JF, French JM, Alberti KG, O'Connell JE. Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Age and ageing. 2004;33:71-77
36. Woo D, Gebel J, Miller R, Kothari R, Brott T, Khoury J, et al. Incidence rates of first-ever ischemic stroke subtypes among blacks: A population-based study. Stroke. 1999;30:2517-2522
37. Kernan WN, Viscoli CM, Inzucchi SE, Brass LM, Bravata DM, Shulman GI, et al. Prevalence of abnormal glucose tolerance following a transient ischemic attack or ischemic stroke. Archives of internal medicine. 2005;165:227-233
38. Hier DB, Foulkes MA, Swiontoniowski M, Sacco RL, Gorelick PB, Mohr JP, et al. Stroke recurrence within 2 years after ischemic infarction. Stroke. 1991;22:155-161
39. Callahan A, Amarenco P, Goldstein LB, Sillesen H, Messig M, Samsa GP, et al. Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: Secondary analysis of the stroke prevention by aggressive reduction in cholesterol levels (sparcl) trial. Archives of neurology. 2011;68:1245-1251
40. Petty GW, Brown RD, Jr., Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: A population-based study in rochester, minnesota, 1975 through 1989. Neurology. 1998;50:208-216
41. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403
42. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose for prevention of type 2 diabetes mellitus: The stop-niddm randomised trial. Lancet (London, England). 2002;359:2072-2077
43. Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: A randomised controlled trial. Lancet (London, England). 2006;368:1096-1105
44. DeFronzo RA, Tripathy D, Schwenke DC, Banerji M, Bray GA, Buchanan TA, et al. Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med. 2011;364:1104-1115
45. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: A scientific statement from the american heart association and the american diabetes association. Diabetes care. 2007;30:162-172
46. Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: A meta-analysis. Lancet (London, England). 2008;371:117-125
47. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the collaborative atorvastatin diabetes study (cards): Multicentre randomised placebo-controlled trial. Lancet (London, England). 2004;364:685-696
48. Cushman WC, Evans GW, Byington RP, Goff DC, Jr., Grimm RH, Jr., Cutler JA, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575-1585
49. Kelly TN, Bazzano LA, Fonseca VA, Thethi TK, Reynolds K, He J. Systematic review: Glucose control and cardiovascular disease in type 2 diabetes. Annals of internal medicine. 2009;151:394-403
50. Ray KK, Seshasai SR, Wijesuriya S, Sivakumaran R, Nethercott S, Preiss D, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: A meta-analysis of randomised controlled trials. Lancet (London, England). 2009;373:1765-1772
51. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-2572
52. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129-139
53. Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52:2288-2298
54. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (ukpds 34). Uk prospective diabetes study (ukpds) group. Lancet (London, England). 1998;352:854-865
55. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the proactive study (prospective pioglitazone clinical trial in macrovascular events): A randomised controlled trial. Lancet (London, England). 2005;366:1279-1289
56. Gallwitz B, Rosenstock J, Rauch T, Bhattacharya S, Patel S, von Eynatten M, et al. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: A randomised, double-blind, non-inferiority trial. Lancet (London, England). 2012;380:475-483
57. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374:1321-1331
58. Ebrahim S, Sung J, Song YM, Ferrer RL, Lawlor DA, Davey Smith G. Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study. BMJ (Clinical research ed.). 2006;333:22
59. Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. Different risk factors for different stroke subtypes: Association of blood pressure, cholesterol, and antioxidants. Stroke. 1999;30:2535-2540
60. Iso H, Jacobs DR, Jr., Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med. 1989;320:904-910
61. Amarenco P, Labreuche J. Lipid management in the prevention of stroke: Review and updated meta-analysis of statins for stroke prevention. Lancet Neurol. 2009;8:453-463
62. Amarenco P, Bogousslavsky J, Callahan A, 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549-559
63. Goldstein LB, Amarenco P, Szarek M, Callahan A, 3rd, Hennerici M, Sillesen H, et al. Hemorrhagic stroke in the stroke prevention by aggressive reduction in cholesterol levels study. Neurology. 2008;70:2364-2370
64. Amarenco P, Goldstein LB, Szarek M, Sillesen H, Rudolph AE, Callahan A, 3rd, et al. Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack: The stroke prevention by aggressive reduction in cholesterol levels (sparcl) trial. Stroke. 2007;38:3198-3204
65. Bang OY, Saver JL, Liebeskind DS, Pineda S, Ovbiagele B. Association of serum lipid indices with large artery atherosclerotic stroke. Neurology. 2008;70:841-847
66. Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, et al. Major lipids, apolipoproteins, and risk of vascular disease. Jama. 2009;302:1993-2000
67. Amarenco P, Goldstein LB, Callahan A, 3rd, Sillesen H, Hennerici MG, O'Neill BJ, et al. Baseline blood pressure, low- and high-density lipoproteins, and triglycerides and the risk of vascular events in the stroke prevention by aggressive reduction in cholesterol levels (sparcl) trial. Atherosclerosis. 2009;204:515-520
68. Bruckert E, Labreuche J, Amarenco P. Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis. Atherosclerosis. 2010;210:353-361
69. Jun M, Foote C, Lv J, Neal B, Patel A, Nicholls SJ, et al. Effects of fibrates on cardiovascular outcomes: A systematic review and meta-analysis. Lancet (London, England). 2010;375:1875-1884
70. Labreuche J, Deplanque D, Touboul PJ, Bruckert E, Amarenco P. Association between change in plasma triglyceride levels and risk of stroke and carotid atherosclerosis: Systematic review and meta-regression analysis. Atherosclerosis. 2010;212:9-15
71. Williams MA, Fleg JL, Ades PA, Chaitman BR, Miller NH, Mohiuddin SM, et al. Secondary prevention of coronary heart disease in the elderly (with emphasis on patients > or =75 years of age): An american heart association scientific statement from the council on clinical cardiology subcommittee on exercise, cardiac rehabilitation, and prevention. Circulation. 2002;105:1735-1743
72. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. Jama. 2003;289:187-193
73. Katsiki N, Ntaios G, Vemmos K. Stroke, obesity and gender: A review of the literature. Maturitas. 2011;69:239-243
74. Yatsuya H, Yamagishi K, North KE, Brancati FL, Stevens J, Folsom AR. Associations of obesity measures with subtypes of ischemic stroke in the aric study. Journal of epidemiology. 2010;20:347-354
75. Vemmos K, Ntaios G, Spengos K, Savvari P, Vemmou A, Pappa T, et al. Association between obesity and mortality after acute first-ever stroke: The obesity-stroke paradox. Stroke. 2011;42:30-36
76. Grundy SM. Metabolic syndrome: Connecting and reconciling cardiovascular and diabetes worlds. Journal of the American College of Cardiology. 2006;47:1093-1100
77. Sakkinen PA, Wahl P, Cushman M, Lewis MR, Tracy RP. Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome. American journal of epidemiology. 2000;152:897-907
78. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet (London, England). 2005;365:1415-1428
79. Sattar N, McConnachie A, Shaper AG, Blauw GJ, Buckley BM, de Craen AJ, et al. Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet (London, England). 2008;371:1927-1935
80. Rodriguez-Colon SM, Mo J, Duan Y, Liu J, Caulfield JE, Jin X, et al. Metabolic syndrome clusters and the risk of incident stroke: The atherosclerosis risk in communities (aric) study. Stroke. 2009;40:200-205
81. Qiao Q, Laatikainen T, Zethelius B, Stegmayr B, Eliasson M, Jousilahti P, et al. Comparison of definitions of metabolic syndrome in relation to the risk of developing stroke and coronary heart disease in finnish and swedish cohorts. Stroke. 2009;40:337-343
82. Wang J, Ruotsalainen S, Moilanen L, Lepisto P, Laakso M, Kuusisto J. The metabolic syndrome predicts incident stroke: A 14-year follow-up study in elderly people in finland. Stroke. 2008;39:1078-1083
83. Kurth T, Logroscino G. The metabolic syndrome: More than the sum of its components? Stroke. 2008;39:1068-1069
84. Giugliano D, Ceriello A, Esposito K. Are there specific treatments for the metabolic syndrome? The American journal of clinical nutrition. 2008;87:8-11
85. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: Updated recommendation for adults from the american college of sports medicine and the american heart association. Circulation. 2007;116:1081-1093
86. Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: A meta-analysis. Stroke. 2003;34:2475-2481
87. Endres M, Gertz K, Lindauer U, Katchanov J, Schultze J, Schrock H, et al. Mechanisms of stroke protection by physical activity. Annals of neurology. 2003;54:582-590
88. MacKay-Lyons M, Gubitz G, Giacomantonio N, Wightman H, Marsters D, Thompson K, et al. Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (prevent trial): A multi-centred, randomised controlled trial. BMC neurology. 2010;10:122
89. Studenski S, Duncan PW, Perera S, Reker D, Lai SM, Richards L. Daily functioning and quality of life in a randomized controlled trial of therapeutic exercise for subacute stroke survivors. Stroke. 2005;36:1764-1770
90. Sacco RL, Gan R, Boden-Albala B, Lin IF, Kargman DE, Hauser WA, et al. Leisure-time physical activity and ischemic stroke risk: The northern manhattan stroke study. Stroke. 1998;29:380-387
91. Fung TT, Stampfer MJ, Manson JE, Rexrode KM, Willett WC, Hu FB. Prospective study of major dietary patterns and stroke risk in women. Stroke. 2004;35:2014-2019
92. Stewart RA, Wallentin L, Benatar J, Danchin N, Hagstrom E, Held C, et al. Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease. Eur Heart J. 2016;37:1993-2001
93. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 aha/acc guideline on lifestyle management to reduce cardiovascular risk: A report of the american college of cardiology/american heart association task force on practice guidelines. Journal of the American College of Cardiology. 2014;63:2960-2984
94. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33:1635-1701
95. Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Ruiz-Gutierrez V, Covas MI, et al. Effects of a mediterranean-style diet on cardiovascular risk factors: A randomized trial. Annals of internal medicine. 2006;145:1-11
96. Preis SR, Stampfer MJ, Spiegelman D, Willett WC, Rimm EB. Lack of association between dietary protein intake and risk of stroke among middle-aged men. The American journal of clinical nutrition. 2010;91:39-45
97. Bonita R, Scragg R, Stewart A, Jackson R, Beaglehole R. Cigarette smoking and risk of premature stroke in men and women. British medical journal (Clinical research ed.). 1986;293:6-8
98. Putaala J, Kurkinen M, Tarvos V, Salonen O, Kaste M, Tatlisumak T. Silent brain infarcts and leukoaraiosis in young adults with first-ever ischemic stroke. Neurology. 2009;72:1823-1829
99. Oono IP, Mackay DF, Pell JP. Meta-analysis of the association between secondhand smoke exposure and stroke. Journal of public health (Oxford, England). 2011;33:496-502
100. You RX, Thrift AG, McNeil JJ, Davis SM, Donnan GA. Ischemic stroke risk and passive exposure to spouses' cigarette smoking. Melbourne stroke risk factor study (merfs) group. American journal of public health. 1999;89:572-575
101. Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths: Confounding in the courtroom. Jama. 2000;284:706-712
102. Fagerstrom K. The epidemiology of smoking: Health consequences and benefits of cessation. Drugs. 2002;62 Suppl 2:1-9
103. Guiraud V, Amor MB, Mas JL, Touze E. Triggers of ischemic stroke: A systematic review. Stroke. 2010;41:2669-2677
104. Sundell L, Salomaa V, Vartiainen E, Poikolainen K, Laatikainen T. Increased stroke risk is related to a binge-drinking habit. Stroke. 2008;39:3179-3184
105. Ois A, Gomis M, Rodriguez-Campello A, Cuadrado-Godia E, Jimenez-Conde J, Pont-Sunyer C, et al. Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke. Stroke. 2008;39:1717-1721
106. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: A systematic review and meta-analysis. BMJ (Clinical research ed.). 2011;342:d671
107. Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Lifestyle factors on the risks of ischemic and hemorrhagic stroke. Archives of internal medicine. 2011;171:1811-1818
108. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies. BMJ (Clinical research ed.). 2011;342:d636
109. Mukamal KJ, Massaro JM, Ault KA, Mittleman MA, Sutherland PA, Lipinska I, et al. Alcohol consumption and platelet activation and aggregation among women and men: The framingham offspring study. Alcoholism, clinical and experimental research. 2005;29:1906-1912
110. Briasoulis A, Agarwal V, Messerli FH. Alcohol consumption and the risk of hypertension in men and women: A systematic review and meta-analysis. Journal of clinical hypertension (Greenwich, Conn.). 2012;14:792-798
111. Baliunas DO, Taylor BJ, Irving H, Roerecke M, Patra J, Mohapatra S, et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes care. 2009;32:2123-2132
112. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The euro heart survey on atrial fibrillation. Chest. 2010;137:263-272
113. Osherov AB, Borovik-Raz M, Aronson D, Agmon Y, Kapeliovich M, Kerner A, et al. Incidence of early left ventricular thrombus after acute anterior wall myocardial infarction in the primary coronary intervention era. American heart journal. 2009;157:1074-1080
114. Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis. Journal of the American College of Cardiology. 1993;22:1004-1009
115. Vandvik PO, Lincoff AM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso-Coello P, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141:e637S-e668S
116. Mahajan N, Ganguly J, Simegn M, Bhattacharya P, Shankar L, Madhavan R, et al. Predictors of stroke in patients with severe systolic dysfunction in sinus rhythm: Role of echocardiography. International journal of cardiology. 2010;145:87-89
117. Freudenberger RS, Hellkamp AS, Halperin JL, Poole J, Anderson J, Johnson G, et al. Risk of thromboembolism in heart failure: An analysis from the sudden cardiac death in heart failure trial (scd-heft). Circulation. 2007;115:2637-2641
118. Pullicino PM, Halperin JL, Thompson JL. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology. 2000;54:288-294
119. Coulshed N, Epstein EJ, McKendrick CS, Galloway RW, Walker E. Systemic embolism in mitral valve disease. British heart journal. 1970;32:26-34
120. Daley R, Mattingly TW, Holt CL, Bland EF, White PD. Systemic arterial embolism in rheumatic heart disease. American heart journal. 1951;42:566-581
121. 9. Cardiovascular disease and risk management. Diabetes care. 2017;40:S75-s87
122. Chen PH, Gao S, Wang YJ, Xu AD, Li YS, Wang D. Classifying ischemic stroke, from toast to ciss. CNS neuroscience & therapeutics. 2012;18:452-456
123. Adams HP, Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 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
124. Jerrard-Dunne P, Cloud G, Hassan A, Markus HS. Evaluating the genetic component of ischemic stroke subtypes: A family history study. Stroke. 2003;34:1364-1369
125. Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, Licata G. Risk factors profile and clinical outcome of ischemic stroke patients admitted in a department of internal medicine and classified by toast classification. International angiology : a journal of the International Union of Angiology. 2006;25:261-267
126. Goldstein LB, Jones MR, Matchar DB, Edwards LJ, Hoff J, Chilukuri V, et al. Improving the reliability of stroke subgroup classification using the trial of org 10172 in acute stroke treatment (toast) criteria. Stroke. 2001;32:1091-1098
127. Meschia JF, Barrett KM, Chukwudelunzu F, Brown WM, Case LD, Kissela BM, et al. Interobserver agreement in the trial of org 10172 in acute stroke treatment classification of stroke based on retrospective medical record review. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2006;15:266-272
128. Selvarajah JR, Glaves M, Wainwright J, Jha A, Vail A, Tyrrell PJ. Classification of minor stroke: Intra- and inter-observer reliability. Cerebrovascular diseases (Basel, Switzerland). 2009;27:209-214
129. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovascular diseases (Basel, Switzerland). 2009;27:493-501
130. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to stroke subtyping: The a-s-c-o (phenotypic) classification of stroke. Cerebrovascular diseases (Basel, Switzerland). 2009;27:502-508
131. Gao S, Wang YJ, Xu AD, Li YS, Wang DZ. Chinese ischemic stroke subclassification. Frontiers in neurology. 2011;2:6
132. Hendrikse J, Zwanenburg JJ, Visser F, Takahara T, Luijten P. Noninvasive depiction of the lenticulostriate arteries with time-of-flight mr angiography at 7.0 t. Cerebrovascular diseases (Basel, Switzerland). 2008;26:624-629
133. Ay H, Benner T, Arsava EM, Furie KL, Singhal AB, Jensen MB, et al. A computerized algorithm for etiologic classification of ischemic stroke: The causative classification of stroke system. Stroke. 2007;38:2979-2984
134. Arsava EM, Helenius J, Avery R, Sorgun MH, Kim GM, Pontes-Neto OM, et al. Assessment of the predictive validity of etiologic stroke classification. JAMA neurology. 2017;74:419-426
135. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Annals of neurology. 2005;58:688-697
136. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: Findings from the global burden of disease study 2010. Lancet (London, England). 2014;383:245-254
137. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (dalys) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the global burden of disease study 2010. Lancet (London, England). 2012;380:2197-2223
138. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: A systematic analysis for the global burden of disease study 2013. Lancet Neurol. 2016;15:913-924
139. Fisher M, Wakhloo A. Dawning of a new era for acute stroke therapy. Stroke. 2015;46:1438-1439
140. Menon BK, Campbell BC, Levi C, Goyal M. Role of imaging in current acute ischemic stroke workflow for endovascular therapy. Stroke. 2015;46:1453-1461
141. Fisher M, Moores L, Alsharif MN, Paganini-Hill A. Definition and implications of the preventable stroke. JAMA neurology. 2016;73:186-189
142. Leoo T, Lindgren A, Petersson J, von Arbin M. Risk factors and treatment at recurrent stroke onset: Results from the recurrent stroke quality and epidemiology (resque) study. Cerebrovascular diseases (Basel, Switzerland). 2008;25:254-260
143. Xian Y, O'Brien EC, Liang L, Xu H, Schwamm LH, Fonarow GC, et al. Association of preceding antithrombotic treatment with acute ischemic stroke severity and in-hospital outcomes among patients with atrial fibrillation. Jama. 2017;317:1057-1067
144. McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B, et al. Case management for blood pressure and lipid level control after minor stroke: Prevention randomized controlled trial. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2014;186:577-584
145. Brewer L, Mellon L, Hall P, Dolan E, Horgan F, Shelley E, et al. Secondary prevention after ischaemic stroke: The aspire-s study. BMC neurology. 2015;15:216
146. Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R, et al. Control of main risk factors after ischaemic stroke across europe: Data from the stroke-specific module of the euroaspire iii survey. European journal of preventive cardiology. 2015;22:1354-1362
147. Brott T, Adams HP, Jr., Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: A clinical examination scale. Stroke. 1989;20:864-870
148. Fischer U, Cooney MT, Bull LM, Silver LE, Chalmers J, Anderson CS, et al. Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: A population-based study. Lancet Neurol. 2014;13:374-384
149. McDonnell MN, Hillier SL, Hooker SP, Le A, Judd SE, Howard VJ. Physical activity frequency and risk of incident stroke in a national us study of blacks and whites. Stroke. 2013;44:2519-2524
150. White CL, Szychowski JM, Roldan A, Benavente MF, Pretell EJ, Del Brutto OH, et al. Clinical features and racial/ethnic differences among the 3020 participants in the secondary prevention of small subcortical strokes (sps3) trial. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22:764-774
151. Benavente OR, Hart RG, McClure LA, Szychowski JM, Coffey CS, Pearce LA. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012;367:817-825
152. Weimar C. Stroke of undetermined cause: Workup and secondary prevention. Current opinion in neurology. 2016;29:4-8
153. Ovbiagele B. Pathways and tools of stroke protect: A hospital-based recurrent stroke prevention program. Critical pathways in cardiology. 2009;8:151-155
