Continuum CVA risk factors:TIA DM lipids

TIA-- annual stroke risk is 1-15 %. In hospital referred, annual risk of stroke, MI or death was 75. % (Hankey 1991). Amaurosis not as bad. 10 % of those with TIA got stroke and 25 % an AE within 90 days. HALF THE PATIENTS WITH STROKE DEVELOPED STROKE WITHIN 2 DAYS OF TIA. Risk factors for stroke after tia included age, duration > 10 minutes, dm, weakness, speech impairment.

Diabestes has an independent effect on stroke demonstrated in the Honolulu heart program (2x risk) and a large population based study of 14,000 found fbs>140 was associated with rr of stroke of 2.26 after adjusting for other risk factors Folsom et al. 1999). One study found a greater effect among women with stroke. Attributable risk of stroke to diabetes was higher in N Manhattan Stroke study due to 22 % prevalence of dm. Insulin resistance was associated with 1.19 rr of cva (Folsom 1999). ADA now classifies fbs>110 as diabetic, aqnd 100-109 as prediabetic.

LIPIDS- increased TG, total cholesterol and LDL are risk factors. For LDL relation to stroke is "less clear" than for IHD with mixed study results. One large meta-analysis of 450,000 found no relation to stroke. By subtype, large artery disease may be more related to cholesterol. HDL may be protective per N Manhattan Stroke Study with higher HDL helping elderly. Statins help.