Cigarette smoking is an independent risk factors that is DOSE DEPENDENT (Gorelick, 1989). A meta-analysis found a rr of cigarettes was 1.5 (Shinton,Beevers 1989) . Passive exposure to smoke increased the progression of atherosclerosis (Howard et al 1998). By stroke subtype, rr is, ICH .74; ischemic stroke 1.92; SAH 2.93. Dose dependent: rr of <10 20 ="1.82." 74=" 1.75;">60 grams/da leads ot rr of 1.64. , hem stroke is 2.18. Less than 12 grams/day shows rr of .8.
Physical activity -1994 Behavioral risk factor surveillance shows increased physical activity lowers stroke risk. Northern Manhattan Study showed physical activity led to 63 % reduction of risk of recurrent stroke. Both exercise intensity and duration is key. Suggest 30 minutes per day of moderate activity.
Diet results conflicting . However moderately increased homocysteine in a risk factor for stroke. However, Vitamin in stroke trial showed no benefit of treatment with b6 b12 and folate. FRUIT and vegetable increased intake lowers stroke risk. Cruciferous and green leafy vegetable and citrus protects against ischemic stroke more. May be due to antioxidants. Milk, calcium, cereal fiber, and fish consumption and carotenoids may be helpful. Limited saturated fat consumption may be important.
Abdominal obesity is an independent risk factor. Men with waist-hip ratios of more than 0.93 and women above .86 have more stroke especially in younger patients. FFA (free fatty acids) and TNF alpha lead to insulin resistance.
Other nontraditional risk factors for stroke are mitral annular calcification, mitral valve prolapse, aortic arch atherosclerosis, PFO, exogenous estrogens, chronic infections, migraine and hypercoagulable state.
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