Preventable stroke and its interplay with stroke subtypes

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.