Related Subjects:
|Subarachnoid Haemorrhage
|Perimesencephalic Subarachnoid haemorrhage
|Haemorrhagic stroke
|Cerebellar Haemorrhage
|Putaminal Haemorrhage
|Thalamic Haemorrhage
|ICH Classification and Severity Scores
|Brain Herniation syndromes
|Epidural Haematoma
📊 Epidemiology
- ➡️ Around 150,000 people have a stroke in the UK each year.
- ⚰️ Stroke causes ~53,000 deaths annually in the UK - the 3rd most common cause of death after heart disease and cancer.
- 👨 Men: 9% of deaths due to stroke; 👩 Women: 13%.
- ♿ ~450,000 people in England live with severe disability after stroke.
- 💷 Economic burden: £2.8 billion direct NHS cost, £1.8 billion wider economy, £2.4 billion informal care.
- 🏥 Stroke patients occupy 20% of acute hospital beds and 25% of long-term care beds.
- ✅ Stroke units save lives: mortality is 14–25% higher on general wards compared to stroke units.
- 📌 Each year, >130,000 people in England & Wales have a stroke; ~10,000 occur in people under retirement age.
🌍 Incidence & Prevalence
- 📉 UK and European data suggest falling stroke incidence due to better risk factor control (smoking cessation, BP control, statins, antiplatelets).
- Population-based incidence (per 100,000/year): Minnesota 556, Copenhagen 406, China 719 - showing variation by geography and lifestyle.
⚠️ Risk Factors
- Non-modifiable: age, sex, ethnicity, hereditary predisposition, prior stroke.
- Modifiable: hypertension, smoking, diabetes, hyperlipidaemia, atrial fibrillation, sickle cell disease.
- Potentially modifiable: obesity, sedentary lifestyle, alcohol/drug misuse, hyperhomocysteinaemia, oral contraceptives, HRT, carotid stenosis.
📈 Hypertension
- Present in 60% at age 60 and 70% at age 70.
- Strongest risk factor for both ischaemic and haemorrhagic stroke.
- Every 10 mmHg ↑ in SBP → stroke risk ↑ ~1.9x in men, 1.7x in women.
- Isolated systolic hypertension is particularly dangerous in older adults.
🧪 Lipids
- High cholesterol and LDL → ↑ carotid atheroma and ischaemic stroke risk.
- Low HDL is a risk marker.
- ⚠️ Very low cholesterol may paradoxically increase haemorrhagic stroke risk.
🍬 Diabetes Mellitus
- Increases stroke risk by 1.5–3x; affects both large and small vessels.
- Intensive glucose control reduces microvascular complications (retinopathy, nephropathy) but not macrovascular events like stroke.
- BP control (target ≤130/85 mmHg) is more effective for stroke prevention than glucose lowering alone.
🚬 Smoking
- Independent risk factor: ~1.5x higher risk of stroke.
- Dose-dependent: more cigarettes → higher risk.
- Accelerates atherosclerosis and potentiates other risk factors.
🍷 Alcohol
- Heavy intake → ↑ haemorrhagic stroke risk.
- Low–moderate intake may reduce ischaemic stroke risk, though evidence is inconsistent.
🏃 Physical Inactivity
- Sedentary lifestyle associated with ↑ stroke risk, partly via obesity, diabetes, and hypertension.
🧬 Hyperhomocysteinaemia
- Homocysteine metabolism depends on vitamins B6, B12, and folate.
- Deficiency → elevated homocysteine → ↑ risk of IHD, carotid disease, stroke.
- Clinical trials have not shown clear benefit from vitamin supplementation.
💊 Oestrogen Use
- Older high-dose OCPs increased stroke risk (meta-analysis: OR ~2.75); newer low-dose (<50 mcg) OCPs carry lower risk (~1.65).
- Absolute risk remains small but must be weighed against pregnancy-related stroke risk (which is higher).
- Postmenopausal HRT associated with small ↑ in stroke risk.
🫀 Carotid Disease
- Symptomatic carotid stenosis (>70%) carries ~26% 2-year stroke risk without intervention.
- Asymptomatic >70% stenosis: ~1–3% annual risk.
⚡ TIA
- Strong predictor of future stroke: 6-month risk ~17%.
- ~10% risk at 90 days; half occur within the first 48 hours.
💓 Atrial Fibrillation
- AF with valvular disease → 20x stroke risk.
- AF without valvular disease → ~5x risk.
❤️ Cardiac Risk Factors
- Ischaemic heart disease, LVH, and heart failure all increase stroke risk.
- Valvular disease (mitral stenosis, prosthetic valves, endocarditis) → major embolic source.
- PFO + atrial septal aneurysm, aortic arch atheroma, and spontaneous LA contrast are also associated with embolic stroke.
