Risk factors and causes of stroke. Stroke: risk factors

Ischemic stroke (IS), hemorrhagic stroke (HI), and transient ischemic attacks (TIA) are commonly referred to as acute cerebrovascular accidents. Stroke (I) is a heterogeneous clinical syndrome of brain injury associated with acute impairment of central or cerebral hemodynamics. The problem of stroke prevention (S) has become especially acute in recent decades when the trend towards an increase in morbidity and mortality from acute cerebrovascular accident (ACV) became apparent. Currently, every 10th death in the world is associated with a stroke - only about six million cases annually. The burden of stroke (a complex of medical, social and financial problems) places an unsustainable burden on the health systems of both economically developed and low-income countries. Treating a patient with a stroke costs about 10 times more than treating a patient with myocardial infarction. Stroke prevention (both primary and secondary) requires significant organizational efforts, new diagnostic methods, and expensive drugs. This affects the availability of medical care and the effectiveness of preventive care. As a result, the prevalence of I in low- and middle-income countries is about 2 times higher than in advanced economies. The incidence of stroke in China over the past 20 years has increased by 50% and almost all of this growth occurred during the period of economic development of the country. Mortality from a stroke (the ratio of deaths to the number of cases) depends on the state of emergency care and the ability of the healthcare system to provide further treatment of the patient and his rehabilitation. In recent years, in most economically developed countries, mortality in the acute period of stroke has decreased markedly, but within a year after stroke, almost 40% of patients still die. Mortality (the ratio of the number of deaths to the population) from stroke is closely related to the incidence and effectiveness of prevention measures. In the Russian Federation, mortality from stroke is an order of magnitude higher than in the United States (251 and 32 per 100,000, respectively). In general, disease-related deaths of cardio-vascular system in the Russian Federation is 7 times higher than in European countries with the same prevalence of diseases associated with atherosclerosis.

So, the number of stroke victims is growing along with the incidence, and the decrease in mortality does not reduce, but increases the burden of stroke. After all, the absolute number of patients requiring secondary prevention measures and expensive rehabilitation is increasing. The only way to reduce the severity of the problem of stroke is to reduce the incidence by increasing the effectiveness of prevention. But an increase in the cost of preventive programs (today in most countries of the world they account for about 3% of funds allocated to health care) is possible within a limited range. Expansion and deepening of the scope of the survey to a level that allows you to determine the obvious and hidden mechanisms of diseases of the circulatory system, even the most developed economy will not withstand. The concept of risk factors (RF) is at the heart of the modern population strategy for the prevention of IH. The most important cardiovascular risk factors are: obesity, sedentary lifestyle, arterial hypertension, diabetes, tobacco smoking, alcohol abuse, lipid metabolism disorders - dyslipidemia. Managing these factors determines the success of prevention programs. How successful is this strategy in modern world? Kim A.S., Johnston S.C. (2013) analyzed the dynamics of the most significant cardiovascular risk factors (Table 1). As can be seen from the table, only arterial hypertension can be controlled more or less effectively: average level BP dropped by 10 mm Hg. st in the US and 8 mm Hg. st in Japan.

Table 1. Major cardiovascular risk factors (median). 25-year dynamics in the population of the USA, Japan and China.

Countries	Risk factors	1980	2005	Trend
USA	Cholesterol (mg/dl)	220	200	↓
	Body mass index	25	27
	Systolic BP (mm Hg)	130	120	↓
	Glucose (mg/dl)	95	103
Japan	Cholesterol (mg/dl)	185	200
	Body mass index	22	23
	Systolic BP (mm Hg)	135	127	↓
	Glucose (mg/dl)	89	97
China	Cholesterol (mg/dl)	165	175
	Body mass index	22	23
	Systolic BP (mm Hg)	128	125	↓
	Glucose (mg/dl)	96	98

The number of patients with overweight and metabolic syndrome in most countries is steadily increasing. The population of developed countries is predominantly over-fed and leads a sedentary lifestyle. According to the latest WHO report (2014), Europe has the highest level of alcohol consumption per capita.

In conditions of increasing complexity and cost of the diagnostic process, insufficient effectiveness of methods for preventing vascular accidents, the choice of a high-risk strategy seems to be the best solution to the problem. The essence of the idea is to reduce the number of patients requiring complex methods of diagnosis and treatment. The full potential of modern medical technologies should be directed to this limited circle of patients. There are not as many patients with a really high risk of stroke as one might think. It is possible to foresee a catastrophic development of events, to single out a relatively small group of those who are really in danger from a huge mass of patients, based on methods for assessing individual risk. The prevalence in the population of diseases of the cardiovascular system leading to stroke (atherosclerosis, arterial hypertension, cardiac ischemia) is very high, and severe complications occur relatively rarely - only in 1% of patients. This fact inevitably leads to the conclusion that in a patient suffering from “usual age-related” diseases, this is an unlikely event, which is caused by special circumstances and fatal changes in the nature of the disease, its behavior. In order to identify high-risk groups, one must rely on the exact knowledge that is obtained by analyzing the results of population-based studies such as the Framingham Heart Study. This long-term population study has shown the association of the most important risk factors with the incidence of I. It is well known, for example, that the annual risk of I increases with age. If in the age group of 45-54 years it is 1 case per 1000 people, then at the age of 75-84 years it is 1 case per 50 people. Similar data exist for other risk factors. Tobacco smoking increases the risk of I by 2 times. An increase in blood pressure by 10 mm Hg in relation to the norm - 2-3 times. In recent years, population risks have been refined not only for patients, but also for healthy people. Statistical analysis methods have established, for example, that the 10-year risk of cardiovascular events for a non-smoking white man aged 44-79 years who does not suffer from arterial hypertension (AH), dyslipidemia and diabetes mellitus is 5.3% (2.1% for a white woman ) . However, individual forecasting based on relative population risks is methodologically incorrect and extremely unreliable. These data are important only in order to obtain a “zero”, indicative point of population risk. Individual risk will never meet this point and may vary quite significantly due to the many characteristics and circumstances inherent in the individual.

The EURO SCORE scale is a generally accepted system for assessing cardiovascular risk based on the results of population studies.

On this scale, the 10-year risk of fatal vascular events can be as high as 20%, depending on the influence of the most important risk factors such as hypertension, smoking, age, and hypercholestrinemia (high risk). The visibility and emphasis on correctable risk factors is an undoubted advantage of this scale, stimulating patients to change their lifestyle. But the coincidence of an individual forecast with real events is unlikely. Recent recommendations for the treatment of hypertension define a moderate risk of serious vascular events as equal to or greater than 7.5% over 10 years. Thus, the ten-year risk gradations of I, myocardial infarction or vascular death are distributed approximately as follows: low risk is less than 7.5%, medium: 7 - 15%, high - more than 15%. The stratification of total cardiovascular risk into categories of low, medium, high and very high is also used in the ESH/ESC 2013 Guidelines. This prognostic system is based on AH, the most important hemodynamic syndrome pathogenetically associated with most vascular events.

Table 2 ESH/ESC 2013 total CV risk stratification

Other risk factors, asymptomatic target organ damage or associated diseases	Blood pressure (mm Hg)
	High Normal SBP 130-139 Or DBP 85-89	AH 1 degree SBP 140-159 or DBP 90-99	AH 2nd degree SBP 160-179 or DBP 100-109	Grade 3 hypertension SBP >180 or DBP >110
No other risk factors		low risk	Medium risk	high risk
1-2 risk factors	low risk	Medium risk	Medium and high risk	high risk
3 or more risk factors	Low and medium risk	Medium and high risk	high risk	high risk
Target organ damage, stage 3 CKD, or diabetes	Medium and high risk	high risk	high risk	High and very high risk
Clinically overt cardiovascular disease, CKD > stage 4, or diabetes with end-organ damage or risk factors	Very high risk	Very high risk	Very high risk	Very high risk

BP - blood pressure; AH - arterial hypertension; CKD - chronic illness kidneys; DBP, diastolic blood pressure; SBP, systolic blood pressure;

Prior to 1994, blood pressure values ​​were the only criterion for assessing the degree of risk. Subsequently, the concept of total risk was introduced, which takes into account the negative impact of other factors that together determine a more severe prognosis. However, assessing the overall risk proved to be a difficult task, since the dependence of vascular events on risk factors is not linear. Numerous attempts to refine the forecast using mathematical formulas were unsuccessful - the methods turned out to be cumbersome and did not increase the accuracy of predictions. More and more additions had to be introduced, which in the latest versions of recommendations and guidelines cover more than 30 FRs. As a result, experts state that "any threshold for determining high cardiovascular risk is arbitrary." The predictive accuracy of the ESH/ESC risk stratification system is not high, but it allows, based on objective criteria, to identify a high-risk group. The disadvantage of this scale is that the range of patients is too wide, which falls into the high-risk category.

The sensitivity of the forecasting method depends on the choice of the leading syndrome that can lead to I. The closer the pathogenetic relationship of the analyzed syndromes with vascular events, the more accurate the forecast. For patients with cardiac arrhythmias, the CHA2DS2VASc scale is more reliable.

Table 3. CHA 2 DS 2 VAS c scale

CABG - coronary artery bypass grafting; TIA - transient ischemic attacks.

The scale is intended to determine the indications for prescribing anticoagulants in patients with atrial fibrillation, and its prognostic value seems to be significant. Together with the sum of points, the annual risk increases I: 1-2 points - 4.5%; 8-9 points - 18 - 24%. At the same time, the scale also takes into account other important risk factors (age, diabetes), which undoubtedly refines the prognosis. The introduction of points into the structure of the scale is a methodological technique that allows you to rank risks, giving them different weights. An example of such a prognostic system is the ESRS risk assessment scale for recurrent cardiovascular complications.

Table 4. ESRS scale

CHF - chronic heart failure; MI - myocardial infarction.

A score of 3 or more indicates a 4% annual risk of serious complications, and this risk is assessed as high. Notably, the risk score for recurrent vascular events increases by an order of magnitude compared to the 10-year SCORE risk.

New prognostic systems are always focused on annual risk assessment and, as a rule, are associated with clinical, coagulopathic, and hemodynamic syndromes “responsible” for the development of stroke. Numerous clinical studies high degree of significance showed a close association of representative syndromes with the annual risk of AND. The value of this risk for hypertension is 4-7%, for arrhythmia - 2-12%, for hypercoagulation syndrome - 5-7%, for stenosing atherosclerotic processes of the main arteries of the brain - 4-12%. These generalizations allowed us to propose a "five percent" I risk scale.

Table 5. Five Percent Stroke Risk Scale

The scale is convenient for practitioners and is more accurate in comparison with systems based on age and nosological criteria. Low risk is defined as 5% or less (1 syndrome), moderate risk - 5 - 10% (2 syndromes), high risk - 10 - 15% (three syndromes), very high risk - 3 - 4 syndromes. The border of low and moderate risk serves as the basis for making a decision on preventive treatment (prescription of antithrombotic agents, statins and other drugs).

Current risk scoring systems show good sensitivity when used to estimate the likelihood of recurrent vascular events. This is not surprising, because more than 30% of patients affected by stroke suffer stroke or myocardial infarction for 5 years, and transient ischemic attacks (TIA) in 20% of patients lead to a stroke within a month.

ABCD scale ( Age, B load pressure, C linical Features, D uration of symptoms, D iabetes mellitus), which is used to assess the likelihood of stroke in patients with TIA, in addition to the main risk factors, it takes into account important dynamic characteristics of the disease: the duration of clinical manifestations.

Stroke risk score after TIA - ABCD

1. Age over 60 years - 1 point
2. Blood pressure on admission above 140/90 mm Hg - 1 point
3. Clinical symptoms: limb weakness on one side - 2 points, speech disorders without weakness in the limbs - 1 point
4. Duration of symptoms: 10-60 minutes - 1 point and more than 60 minutes - 2 points
5. Diabetes mellitus - 1 point

A special multicenter prospective study showed that the border of low risk on this scale is at the level of 3 points. The probability of developing I in patients who underwent TIA and received more than 3 points on the ABCD scale is 7 times higher.

Outcome 0-3 points: Low risk
Risk of stroke within 2 days: 1.0%
Risk of stroke within 1 week: 1.2%
Risk of stroke within 3 months: 3.1%

Outcome 4-5 points: Moderate risk
Risk of stroke within 2 days: 4.1%
Risk of stroke within 1 week: 5.9%
Risk of stroke within 3 months: 9.8%

Outcome 6-7 points: High risk
Risk of stroke within 2 days: 8.1%
Risk of stroke within 1 week: 11.7%
Risk of stroke within 3 months: 17.8%

Thus, in patients with obvious signs of cerebrovascular decompensation (TIA), the ABCD scale fairly accurately predicts I.

The prognosis is very important for substantiating the scope of the examination and the choice of medical or surgical treatment. Patients with a low risk of I do not need in-depth examination using imaging techniques of the heart, blood vessels and brain. This allows you to correctly allocate health care resources and optimize working time specialists. On the other hand, patients belonging to the high-risk category should receive a full examination in a timely manner.

Depending on the degree of risk, the methods of preventive treatment also change. For example, antithrombotic therapy is not indicated in patients with a low risk of cardiovascular complications. But patients with high risk gradations should receive aggressive complex treatment, including statins, anticoagulants, antihypertensive drugs, depending on the leading syndromes that can lead to stroke. It is equally important to examine these patients in detail using modern methods imaging (duplex ultrasound, CT scan, MRI). Early diagnosis of cerebrovascular accidents, brain damage and timely surgical or endovascular treatment, if indicated, can prevent I. The doctor's task is to skillfully use prognostic criteria for the benefit of the patient and the prevention of cerebral catastrophe.

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2

1 Far Eastern Federal University

2 Pacific State Medical University of the Ministry of Health of Russia

3 FGBOU VO "Vladivostok State University economy and service"

The article analyzes the risk factors for stroke, which is currently the most important medical and social problem, analyzes the literature that considers the main factors affecting the development of stroke, lifestyle and quality of life. It is noted that the incidence of stroke is increasing worldwide, and this is an alarming factor. Studies highlight the main risk factors for stroke, which are divided into unchangeable (old age, gender, hereditary burden, belonging to an ethnic group, low birth weight) and changeable (arterial hypertension (AH), heart disease, arterial vascular insufficiency of the lower extremities, smoking, diabetes mellitus, carotid artery stenosis, hypercholesterolemia, obesity, lack of physical activity, alcohol abuse, use of oral contraceptives, sleep apnea syndrome, etc.). Unfortunately, cases of the disease tend to rejuvenate. According to many studies, it has been proven that diseases of the cardiovascular system most often lead to the development of ischemic stroke, and tobacco smoking is an independent risk factor for stroke in all population groups, regardless of age, gender and ethnicity. For Russia, this is a significant factor in the development of stroke. The studies carried out confirm that the healthy lifestyle life and regular physical activity can reduce the risk of stroke.

Lifestyle

health level

the quality of life

prevention

risk factors

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An analysis of the main risk factors for stroke shows that today stroke remains the most important medical and social problem not only in Russia, but throughout the world, due to high rates of morbidity, mortality and disability. Stroke is a clinical syndrome represented by focal neurological and / or cerebral disorders, developing suddenly due to acute cerebrovascular accident, persisting for at least 24 hours or ending in death of the patient in these or more early dates. Strokes in everyday practice include cerebral infarctions (ischemic strokes), cerebral hemorrhages (hemorrhagic strokes).

The incidence of stroke is increasing worldwide. According to statistics, every year for every 10,000 people there are 25-30 strokes. More than 4 million cases of stroke are registered in the world a year, of which 519,000 are in Europe. According to statistical analysis, every year in Russia stroke affects about 0.5 million people with an incidence rate of 3 people per 1000 population. In 2015, a stroke claimed 6.24 million human lives in the world. In China, the incidence of stroke in adults aged 40-74 increased from 189 per 100,000 in 2002 to 379 per 100,000 in 2013, according to the Statistical Yearbook. the total annual growth was 8.3%.

Stroke cases tend to rejuvenate. Data obtained by American researchers George M.G., Tong X., Bowman B.A. (2017), based on the analysis of information on hospitalization of young stroke patients National Inpatient Sample (NIS) from 44 states, showed that the incidence of stroke increased in both men and women in young age from 18 to 54 years old. Moreover, from 1995 to 1996 it almost doubled for men aged 18 to 34 years. The incidence of stroke increased by 41.5% among men in the 35 to 44 age group from 2003-2004 to 2011-2012.

In recent years, many works have appeared that highlight the main risk factors for stroke, which are divided into unchangeable (old age, gender, hereditary burden, ethnic group, low birth weight) and changeable (arterial hypertension (AH), heart disease, arterial insufficiency of the vessels of the lower extremities, smoking, diabetes mellitus, carotid stenosis, hypercholesterolemia, obesity, lack of physical activity, alcohol abuse, use of oral contraceptives, sleep apnea syndrome, etc.).

One of the important factors in the occurrence of stroke is age, since with its growth the risk of stroke increases. According to R.D. Brown (1996), starting at the age of 55, the risk of stroke doubles every decade. Risk factors for ischemic stroke are recognized as elderly and senile age (at 80 years of age and older, the risk of ischemic stroke is 30 times higher than at 50 years of age). So, according to J. Chalmers, S. MacMahon, C. Anderson et al. (2000), at the age of 45-54 years, a stroke occurs in 1 person in 1000, while at the age of 75-84 years, in 1 out of 50. Studies have shown that gender is a risk factor for stroke. So, according to the results of the analysis of Appelros P. (2009), the male sex is a risk factor for stroke by 33% more than the female. However, the prevalence of stroke in women is projected to increase rapidly due to the rising average age of the global female population. In terms of prevalence, vascular risk factors differ between women and men. These studies confirm the clinical significance of sex differences in stroke. The influence of some risk factors for stroke, including diabetes mellitus and atrial fibrillation, is higher in women, and hypertension during pregnancy affects the risk of stroke for decades after pregnancy.

There is a hereditary burden of stroke. If parents have had a stroke, the risk of stroke in children increases.

However, in a global study conducted in the period 1990-2013. Feigin V.L., Roth G.A., Naghavi M. et al. (2016) and covering 188 countries, it is noted that more than 90% of the risk of stroke is due to modifiable factors: behavioral (smoking, poor diet and low physical activity), metabolic (high level systolic blood pressure (SBP), high body mass index (BMI), high fasting plasma glucose, high total cholesterol, and low glomerular filtration rate) and factors environment(air pollution and lead).

Tobacco smoking is an independent risk factor for stroke in all populations, regardless of age, gender, and ethnicity. For Russia, this is a significant factor in the development of stroke. Thus, according to the global survey of adults on tobacco consumption in the Russian Federation (2009), in general, 39.1% (43.9 million people) of the adult population of the Russian Federation turned out to be regular tobacco smokers. Among men, 60.2% (30.6 million) are regular smokers, among women - 21.7% (13.3 million). The prevalence of tobacco smoking was highest among adults aged 19 to 24 years (49.8%) and 25 to 44 years (49.6%). In the youngest age group (15-18 years old), the prevalence of tobacco smoking was also quite high and amounted to 24.4%. Therefore, it can be assumed that this factor contributes to the development of stroke in the younger generation.

According to the study by Trajkova S. et al. initial stage(1993-1998), out of 386 cases of stroke, 17% of men and 15% of women were heavy smokers, and 14% of men drank alcohol. It must be remembered that smoking destroys the body at the cellular level and can cause type II diabetes, and this in turn increases the likelihood of a heart attack and other cardiovascular diseases.

According to V.A. Parfyonova, smoking cessation of heavy smokers who have this bad habit for many years contributes to a significant reduction in the risk of ischemic stroke. According to the author, even in elderly people with a very long history of smoking, the effectiveness of smoking cessation or reducing the number of cigarettes smoked has been proven to prevent myocardial infarction and ischemic stroke. Refusal of alcohol abuse gradually leads to a decrease in the risk of stroke in former alcoholics.

In patients hospitalized due to acute ischemic stroke from 2003-2004 to 2011-2012, both in men and women aged 18 to 64 years, a trend towards an increase in risk factors was revealed: hypertension from 4 to 11%, lipid disorders from 12 to 21%, diabetes from 4 to 7%, tobacco use from 5 to 16% and obesity from 4 to 9% (M.G. George, X. Tong, B.A. Bowman, 2017). In addition, there was an increase in the presence of 3 to 5 risk factors for stroke from 2003-2004 to 2011-2012 (in men: from 9 to 16% at 18-34 years of age, from 19 to 35% at the age of 35-44 years, with 24 to 44% at ages 45-54 and 26 to 46% at ages 55-64; in women: 6 to 13% at ages 18-34, 15 to 32% at ages 35-44, from 25 to 44% at 45-54 years old and from 27 to 48% at 55-65 years old (M.G. George, X. Tong, B.A. Bowman, 2017) .

In recent years, scientists have repeatedly addressed the topic of weight gain and obesity among the population as one of the risk factors for stroke. Such attention of researchers to this problem is not accidental: according to WHO, in 2016 more than 1.9 billion people over 18 years old were overweight in the world, of which over 650 million people were obese. Elevated BMI is considered one of the main risk factors for non-communicable diseases such as: cardiovascular diseases (mainly heart disease and stroke), and in 2012 were main reason of death . With this disease, not only carbohydrate, but also fat and protein metabolism suffer, autoimmune and hormonal changes are noted, the rheological properties of the blood change, the concentration of vital important substances in the body. Diverse changes in cerebral vessels in diabetes mellitus include violations of vascular tone (dystonia), lesions of vessels of various calibers.

Daily physical activity has been shown to reduce the risk of type 2 diabetes and metabolic syndrome. Metabolic syndrome is a complex metabolic disorder in which there is an accumulation of fat around the waist, and leading to increased blood pressure, blood sugar, and the risk of cardiovascular disease. Studies show that a reduction in the risk of stroke occurs if you engage in at least 120 to 150 minutes a week of moderate-intensity aerobic activity. And the higher the levels of physical activity, the lower the risk of stroke.

Regular physical activity helps maintain a healthy mindset in adulthood, helps reduce the risk of depression, and promotes easy and healthy sleep. Studies have shown that aerobic exercise or a combination of aerobic and strength training 3 to 5 times a week for 30 to 60 minutes daily lead to an improvement in the psycho-emotional state.

However, the main etiological risk factors, according to N.V. Vereshchagin, atherosclerosis and uncontrolled arterial hypertension remain. A stroke is the outcome of various pathological conditions of the circulatory system: blood vessels, heart, blood.

According to many studies, diseases of the cardiovascular system, non-infectious primary inflammatory and autoimmune vasculitis, infectious intracranial arteritis, antiphospholipid syndrome, trauma and dissection of the arteries of the neck, and other pathologies most often lead to the development of ischemic stroke.

Arterial hypertension is considered the most significant risk factor for the development of strokes and leads to an increase in the risk of stroke by 3-4 times. Heart failure is the cause of about a fifth of ischemic strokes, and coronary heart disease increases the risk of their development by about 2 times. According to I.E. Chazov et al. (2003), a decrease in elevated diastolic blood pressure (BP) alone by 5 mm Hg. Art. lead to a 34% reduction in the risk of stroke.

According to many researchers (V.N. Grigorieva, E.V. Guzanova, E.M. Zakharova, 2008, etc.), atherosclerotic lesions of large vessels (ascending aorta, internal carotid and vertebral arteries) serve the most common cause ischemic stroke in persons over 35 years of age and favors the emergence of atherothrombotic and hemodynamic types of stroke. According to studies, the incidence of stroke in patients with osteoarthritis, which in turn is associated with atherosclerosis of the carotid arteries, was 36% higher than in those who did not have this disease. Thrombus formation is facilitated by ulceration of an atherosclerotic plaque, slowing of blood flow, increased platelet aggregation, etc. In the extracranial parts of the vessels, the mouth of the internal carotid or vertebral artery is a favorite place for atherosclerotic deposits and thrombosis (Kadykov A.S., 2003).

Ischemic stroke develops in approximately 2% of patients with myocardial infarction. BEFORE. Webers et al. (1999) argue that a recent myocardial infarction is proven, and myocardial infarction 2-6 months old. - to putative cardiac risk factors for stroke.

The next factor in the occurrence of stroke is rheumatic heart disease. Rheumatism is a systemic inflammatory disease of the connective tissue with a predominant lesion of the cardiovascular system. It develops in connection with an acute infection.

Atrial fibrillation (atrial fibrillation) is a supraventricular tachycardia characterized by a chaotic contraction of individual atrial muscle fibers and accompanied by low cardiac output due to impaired filling of the ventricles with blood and their irregular contraction, is one of the most important proven risk factors for ischemic stroke.

Prolonged stress causes a constant increase in insulin levels, which leads to the deposition of cholesterol on the walls of blood vessels. O.V. Ishanova (2008) singles out excessive stress, loss of spiritual harmony and adequate positive self-esteem as the causes of strokes.

Unfavorable psychosocial working conditions during the past 12 months were found to precede stroke events. Difficult economic situation, lack of confidence in tomorrow, increasing pace of life, high level of ambition, unsuccessful search for suitable work, excessive workload, lack of information or, on the contrary, information overload, quarrels and conflicts at work and at home, plus the costs of urbanization and the deplorable state of the environment - all this causes an overstrain of the nervous systems . Under the influence of emotional stress, the biochemical composition of the blood, the content of electrolytes change, oxygen starvation of the vascular wall occurs, with its subsequent changes.

According to experts, poor sleep can lead to adverse health effects. Observations by Y. Leng, F.P. Cappuccio, N.W.J Wainwright et al. (2015) over 9.5 years for 9,692 participants were associated with sleep duration and its effect on stroke. The authors suggested that 5-6 hours of sleep instead of 8-9 hours of sleep is indicative of cardiovascular disease. Experimental sleep restriction has shown changes in insulin sensitivity, increased blood pressure and overall cholesterol levels, and low lipoprotein density.

The main risk factors for ischemic stroke identified by the researcher E.I. Kimelfeld, as a result of observation of 126 patients (31 women and 95 men) with ischemic stroke or transient ischemic attack aged 18 to 50 years (mean age 41.3 ± 7.0), do not contradict the data obtained in various studies. It was revealed that in this age group such modifiable risk factors as arterial hypertension (AH) (58.7%), smoking (57.1%), carbohydrate metabolism disorders (32.5%), alcohol abuse (26.5%) played an important role. .2%). More than half of the patients had 2 or more modifiable risk factors (61.1%). It was found that at this age men suffered from ischemic stroke three times more often than women. However, the author believes that the role of these factors was not decisive. In favor of the risk of stroke, a hereditary predisposition of patients to diseases of the cardiovascular system was noted (85% of patients).

Diabetes mellitus (DM) is an independent factor in the development of stroke and increases the risk of its occurrence by 2-6 times. Ischemic stroke often develops against the background of diabetes mellitus. According to the Framingham Study, the relative risk of stroke in patients with DM is 1.8-6 times higher than the average population, the risk of death from stroke is 2.8 times higher than in people without DM, and 3.8 times higher if the stroke is ischemic. . The UK Diabetes Research Group found the need for blood pressure control to regulate it (mean blood pressure, 144/82 mmHg), which reduces the risk of stroke by 44%. A 20% risk reduction was observed with antihypertensive therapy in diabetic patients with systolic hypertension in the elderly program.

Thus, the analysis of various scientific domestic and foreign sources, risk factors for the development of stroke gives reason to believe that the basis for the occurrence of stroke are various causes, the contribution of which researchers evaluate differently, and knowledge of them is important for the preventive organization of the fight against this serious disease. .

Bibliographic link

Kaerova E.V., Zhuravskaya N.S., Matveeva L.V., Shestera A.A. ANALYSIS OF THE MAIN RISK FACTORS OF STROKE // Contemporary Issues science and education. - 2017. - No. 6.;
URL: http://site/ru/article/view?id=27342 (date of access: 02/01/2020).

We bring to your attention the journals published by the publishing house "Academy of Natural History"

The main causes leading to the development of strokes

TOPIC: NURSING PROCESS IN CEREBROVASCULAR

BASIC SUMMARY LESSON №3

DISEASES

Stroke (from late Latin - attack) is a state of various etiology and pathogenesis, the realizing link of which is a vascular catastrophe of both the arterial and venous bed. The stroke is acute disorders of cerebral circulation (ACV) characterized by a sudden (within minutes, less often hours) development of focal neurological symptoms (motor, sensory, speech, visual, coordinating) or cerebral disorders (disorders of consciousness, headache, vomiting), which persist for more than 24 hours or lead to the death of the patient in more a short period of time due to cerebrovascular causes. Poor circulation may be in the brain (cerebral stroke) or in the spinal cord (spinal stroke).

Undoubtedly, it is clear to everyone that it is almost impossible to completely cure an already developed stroke, and therefore the activity of medical workers aimed at preventing cerebrovascular diseases is so important. Middle managers should play the most active role in this, as they are the closest to the patient. The above data oblige nursing staff to have good knowledge in this area, and to know not only the etiology, the clinic of strokes and the main problems of patients, but also ways to solve these problems, rehabilitation features, and ergonomic techniques. In the work of a nurse, special importance is attached to the organization of the nursing process and nursing of patients. It is very important to involve the patient's relatives in the organization of care, to teach them the techniques and methods of care at home.

1. Atherosclerosis, arterial hypertension, diseases of the heart and blood vessels (cardiac arrhythmias that occur during myocardial infarction, coronary heart disease, rheumatism and a number of other pathological conditions are considered especially unfavorable. Cardiac pathology contributes to the formation of blood clots in the heart cavities, and cardiac arrhythmias create conditions their entry into the arteries of the brain.

2. Blood diseases (leukemia, anemia, coagulopathy).

3. Anomalies in the development of cerebral vessels (aneurysms, arteriovenous malformations, stenoses).

4. Brain injury.

5. Cervical osteochondrosis, especially in combination with atherosclerosis.

There are two types of stroke risk factors: uncontrolled (unmanaged) and controlled (managed).

Uncontrolled (unmanaged) risk factors:

– age (over 65 years);

- gender (men are somewhat more likely to have a stroke, but women have more severe consequences, especially after the involutionary period);

- race (persons of the black race are affected more often than whites).

Controlled (managed) risk factors:

- arterial hypertension, especially if DBP is greater than or equal to 100 mmHg;

- the presence of coronary artery disease, constant or paroxysmal atrial fibrillation, mitral valve prolapse;

- history of stroke;

- heredity: coronary artery disease or stroke in relatives under the age of 60;

- diseases of the heart and blood vessels (especially unfavorable are cardiac arrhythmias arising from myocardial infarction, coronary heart disease, rheumatism and a number of other pathological conditions). Cardiac pathology contributes to the formation of blood clots in the cavities of the heart, and cardiac arrhythmias create conditions for their drift into the arteries of the brain);

- blood diseases (leukemia, anemia, coagulopathy);

- anomalies in the development of cerebral vessels (aneurysms, arteriovenous malformations, stenoses);

– brain injury;

- cervical osteochondrosis, especially in combination with atherosclerosis.

Acute cerebrovascular accident (ACC) can be of two types:

1. Transient (dynamic) disorders of cerebral circulation, in which neurological symptoms persist for no more than 24 hours. These include:

- transient ischemic attack (TIA) - manifested focal neurological insufficiency, which completely disappears within 24 hours;

- hypertensive crises of the second type, accompanied by the development cerebral symptoms and / or convulsive syndrome;

The diagnosis is usually made retrospectively.

2. Persistent disorders of cerebral circulation - stroke.

There are two types of stroke: ischemic stroke or cerebral infarction (occurs in 80-85% of cases) and hemorrhagic stroke or hemorrhage (in 15-20%).

Ischemic stroke (cerebral infarction) according to the mechanism of development is divided into thrombotic, embolic and non-thrombotic:

– thrombotic and embolic stroke arise due to occlusion of an extra- or intracranial vessel of the head due to thrombosis, embolism, complete occlusion of the vessel by an atherosclerotic plaque, etc. The lumen of the vessel closes completely or partially when an atherosclerotic plaque or thrombus forms at the site of this plaque. This mechanism is more common in a large vessel (aorta, carotid arteries). The lumen of smaller vessels closes, usually, a detached piece of a thrombus from the site of a vascular atherosclerotic plaque or from an intracardiac thrombus (for example, in violation of the heart rhythm). Blood clots, thrombi, develop in the area of ​​atherosclerotic plaques that form on the inner walls of the vessel. Thrombi can completely block even large vessels, causing serious cerebrovascular accidents.

– non-thrombotic (hemodynamic) stroke develops more often as a result of a combination of factors such as atherosclerotic vascular damage, angiospasm, arterial hypotension, pathological tortuosity of the vessel, chronic cerebrovascular insufficiency.

A cerebrovascular accident in which neurological symptoms persist for less than 21 days is called small stroke.

Hemorrhagic stroke occurs due to a violation of the integrity (rupture) of the vascular wall with the penetration of blood into the tissue of the brain, its ventricles or under the membranes. In most patients, rupture of the vessel wall occurs at high blood pressure figures or against the background of an anomaly in the form of a protrusion of the vascular wall (aneurysm), or due to trauma.

According to localization, the following hemorrhages are distinguished:

- parenchymal (intracerebral);

- subarachnoid (subarachnoid);

- parenchymal-subarachnoid (mixed);

- intraventricular;

subdural and epidural hematoma.

CVA occur suddenly (minutes, less often hours) and are characterized by the appearance of focal and/or cerebral and meningeal neurological symptoms. With hemorrhages or extensive ischemic strokes, violations of vital functions develop. With subarachnoid hemorrhage and cerebral edema, the development of a convulsive syndrome is possible.

Clinicalsyndromes characteristic of stroke:

Cerebral symptoms:

- a decrease in the level of wakefulness from subjective sensations of "uncertainty, cloudiness in the head" and a slight stupor to a deep coma;

- headache;

- pain along the spinal roots;

- nausea, vomiting.

Focal neurological symptoms:

- movement disorders (hemiparesis, hyperkinesis, etc.);

- speech disorders (sensory, motor aphasia, dysarthria);

- sensory disorders (hypesthesia, violations of deep, complex types of sensitivity);

- coordinating disorders (vestibular, cerebellar ataxia);

- visual disturbances (loss of visual fields, double vision);

- violations of cortical functions (apraxia, alexia, etc.);

– amnesia, disorientation in time, etc.;

- bulbar syndrome.

Meningeal symptoms:

- tension of the posterior cervical muscles;

- positive symptoms of Kernig, Brudzinsky (upper, middle, lower);

- increased sensitivity to external stimuli;

- typical posture of the patient.

January 28, 2018 No comments

Some of the most important risk factors for stroke can be identified during a physical exam at your doctor's office. If you are over 55, the checklist in this article will help you assess your risk of stroke and demonstrate the benefits of managing stroke risk factors.

Do you know your risk of stroke?

Many risk factors for stroke can be controlled, some very successfully. While the risk will never be zero at any age, starting early and controlling your risk factors can help reduce your risk of death or disability from a stroke. With good prevention, the risk of stroke in most age groups can be lower than with accidental injury or death.

Stroke can be prevented and treated. In recent years, a better understanding of the causes of stroke has helped many people make lifestyle changes that have nearly halved deaths from stroke.

Assess your risk of stroke in the next 10 years - Men

Key: GARDEN Diabetes= history of diabetes; Cigarettes= smokes cigarettes; CVD IF LVH

points	0	+1	+2	+3	+4	+5	+6	+7	+8	+9	+10
Age	55-56	57-59	60-62	63-65	66-68	69-72	73-75	76-78	79-81	83-84	85
SAD-nelech	97-105	106-115	116-125	126-135	136-145	146-155	156-165	166-175	176-185	186-195	196-205
or SAD-lech	97-105	106-112	113-117	118-123	124-129	130-135	136-142	143-150	151-161	162-176	177-205
Diabetes	No		Yes
Cigarettes	No			Yes
	No				Yes
IF	No				Yes
LVH	No					Yes

Your points	Probability 10 years
1	3%
2	3%
3	4%
4	4%
5	5%
6	5%
7	6%
8	7%
9	8%
10	10%
11	11%
12	13%
13	15%
14	17%
15	20%
16	22%
17	26%
18	29%
19	33%
20	37%
21	42%
22	47%
23	52%
24	57%
25	63%
26	68%
27	74%
28	79%
29	84%
30	88%

Assess your risk of a stroke over the next 10 years - women

Key: GARDEN= systolic blood pressure (evaluation of only one line, without treatment or with treatment); Diabetes= history of diabetes; Cigarettes= smokes cigarettes; CVD(cardiovascular disease) = history of heart disease; IF= history of atrial fibrillation; LVH= diagnosis of left ventricular hypertrophy

points	0	+1	+2	+3	+4	+5	+6	+7	+8	+9	+10
Age	55-56	57-59	60-62	63-64	65-67	68-70	71-73	74-76	77-78	79-81	82-84
SAD-nelech		95-106	107-118	119-130	131-143	144-155	156-167	168-180	181-192	193-204	205-216
or SAD-lech		95-106	107-113	114-119	120-125	126-131	132-139	140-148	149-160	161-204	205-216
Diabetes	No			Yes
Cigarettes	No			Yes
Cardiovascular diseases	No		Yes
IF	No						Yes
LVH	No				Yes

Your points	Probability 10 years
1	1%
2	1%
3	2%
4	2%
5	2%
6	3%
7	4%
8	4%
9	5%
10	6%
11	8%
12	9%
13	11%
14	13%
15	16%
16	19%
17	23%
18	27%
19	32%
20	37%
21	43%
22	50%
23	57%
24	64%
25	71%
26	78%
27	84%

Compare with your age group	Average 10-year chance of stroke
55-59	3,0%
60-64	4,7%
65-69	7,2%
70-74	10,9%
75-79	15,5%
80-84	23,9%

Example

This example helps to estimate the risk of stroke. Calculate your scores to determine your risk of having a stroke attack within the next 10 years.

Maria, 65, wanted to determine her risk for a stroke, so she took this stroke risk checklist. This is how she reached her 10-year risk of having a stroke:

Interpretation:
A score of 15 means a 16 percent chance of having a stroke within 10 years. If Maria stops smoking, she can reduce her score to 12, which means a 9 percent chance of having a stroke.

Her current final score does not mean that Maria will definitely have a stroke, but it will serve as an incentive so that she can reduce her risk or even prevent a stroke. A lower percentage score does not mean that Mary will not have a stroke, but that her risk of having one is decreasing.

No matter what your test result is, it is important to work on reducing individual risk factors, as Maria did in this example when she stopped smoking.

By continuing to focus on reducing the risk of stroke, and by using currently available treatments and developing new ones, people could prevent up to 80 percent of all strokes.

In Russia, about 400 thousand strokes occur annually. Among them, ischemic (cerebral infarction) is more common - about 80% of all stroke cases, hemorrhagic strokes (cerebral hemorrhage) occur less frequently - about 15%, and subarachnoid hemorrhage (under the arachnoid membrane of the brain) - about 5%.

Stroke prevention is an urgent problem not only for medicine, but also for society as a whole, because the mortality rate from stroke is high (20-40% die during the first month of the disease), and among the survivors, more than half have a permanent disability.

What brings a stroke closer and to whom does it threaten?

The main risk factor is age. Every year at a young age, only 1 out of 90 thousand of the population develops a stroke, while at the senile age (75-84 years) it occurs in 1 out of 45 people. At age 45, the risk of stroke is relatively low over the next 20 years (occurs in one in 30 people), but its likelihood increases significantly by the age of 80 (it occurs in one in four men and one in five women).

In general, the risk of stroke in men 30% higher than women. However, this is typical only for the age group of the population from 45 to 64 years. Over the age of 65, the risk of stroke in men and women is almost the same.

Other major risk factors for stroke include arterial hypertension , heart disease , previous stroke , smoking, abuse alcohol, high level cholesterol in the blood, excessive consumption salt. There is a mutual influence between many factors, so their combination leads to a greater increase in the risk of disease than a simple arithmetic addition of their isolated action.

How to deal with a stroke?

Traditional medicine knows only two ways to deal with stroke: prevention and symptomatic treatment of the consequences of the disease. "Prevention is better than cure" is a classic saying that applies especially to stroke.

The prevention of a stroke (and its recurrence) consists in the correct mode of work and rest, rational nutrition and sleep regulation, a normal psychological climate in the family and at work, timely treatment of cardiovascular diseases: coronary heart disease, arterial hypertension, atrial fibrillation and others.

US National Stroke Association Guidelines for Stroke Prevention

• Know your blood pressure .

Check it at least once a year. High blood pressure (hypertension) is the leading cause of stroke. If the top number (your systolic blood pressure) is consistently above 140 or if the bottom number (your diastolic blood pressure) is consistently above 90, talk to your doctor.

• Find out if you have atrial fibrillation .

Atrial fibrillation is an irregular heartbeat that interferes with cardiac function and allows blood to pool in parts of the heart, and the stagnant blood can form clots or blood clots. The contractions of the heart can separate part of the thrombus into the general circulation, which can lead to cerebrovascular accident.

• If you smoke, stop .

Smoking doubles the risk of stroke. As soon as you stop smoking, your risk of stroke will immediately begin to decrease, after five years your risk of developing a stroke will be the same as that of non-smokers.

• If you drink alcohol, do it in moderation .

A glass of wine or a glass of beer daily can reduce your risk of having a stroke (unless there are other reasons to avoid alcohol). Drinking more than this amount increases the risk of stroke.

• Find out if you have high cholesterol .

Increasing cholesterol increases the risk of stroke, lowering cholesterol in some people can be achieved by diet and exercise others require drug therapy.

• If you have diabetes, strictly follow your doctor's recommendations for diabetes control .

Having diabetes increases your risk of stroke, but by controlling your diabetes, you can reduce your risk of stroke.

• Use exercise to increase your activity in everyday life .

Get physical exercise daily. Walking for 30 minutes a day can improve your health and reduce your risk of stroke. If you don't like walking, choose other physical activities that suit your lifestyle: cycling, swimming, golf, dancing, tennis, and more.

• A diet low in salt and fat is recommended .

By reducing the amount of salt and fat in your diet, you will lower your blood pressure and, more importantly, lower your risk of stroke. Strive for a balanced diet with a predominance of fresh fruits, vegetables, seafood and a moderate amount of protein daily.