The Stroke Center

Risk Factors

Who is at risk for stroke?

Stroke runs in families. Family members may have a genetic predisposition for stroke or possess a lifestyle characteristic that contributes to stroke.

Primary risk factors for stroke include:

  • high blood pressure
  • heart disease
  • diabetes
  • cigarette
  • smoking
  • overweight
  • sedentary lifestyle

Secondary risk factors include:

  • heavy alcohol consumption
  • high blood cholesterol levels
  • illicit drug use
  • genetic or congenital conditions

Some risk factors apply only to women. These include:

  • pregnancy
  • childbirth
  • menopause

Evaluating the risk for stroke is based on heredity, natural processes, and lifestyle. Many risk factors for stroke can be changed or managed, while others that relate to hereditary or natural processes cannot be changed.

Risk factors for stroke that can be changed, treated, or medically managed:
  • high blood pressure
    The most important controllable risk factor for brain attack is controlling high blood pressure.
  • diabetes mellitus
    Diabetes is treatable, but having it increases the risk for stroke.
  • heart disease
    Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke.
  • cigarette smoking
    The use of oral contraceptives, especially when combined with cigarette smoking, greatly increases stroke risk.
  • history of transient ischemic attacks (TIAs)
    A person who has had one (or more) TIA is almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.
  • high red blood cell count
    A moderate increase in the number of red blood cells thickens the blood and makes clots more likely, thus increasing the risk for stroke.
  • high blood cholesterol and lipids
    High blood cholesterol and lipids increase the risk for stroke.
  • lack of exercise, physical inactivity
    Lack of exercise and physical inactivity increases the risk for stroke.
  • obesity
    Excess weight increases the risk for stroke.
  • excessive alcohol use
    More than two drinks per day raises blood pressure, and binge drinking can lead to stroke.
  • drug abuse (certain kinds)
    Intravenous drug abuse carries a high risk of stroke from cerebral embolisms (blood clots). Cocaine use has been closely related to strokes, heart attacks, and a variety of other cardiovascular complications. Some of them, even among first-time cocaine users, have been fatal.
  • abnormal heart rhythm
    Various cardiac diseases have been shown to increase the risk of stroke. Atrial fibrillation is the most powerful and treatable cardiac precursor of stroke.
  • cardiac structural abnormalities
    New evidence shows that cardiac structure abnormalities including patent foramen ovale and atrial septaldefect increase risk for embolic stroke.
Risk factors for stroke that cannot be changed:
  • age
    For each decade of life after age 55, the chance of having a stroke more than doubles.
  • race
    African-Americans have a much higher risk of death and disability from a stroke than Caucasians, in part because the African-American population has a greater incidence of high blood pressure.
  • diabetes
    Diabetes is strongly linked with high blood pressure and, although diabetes is a treatable condition, increases a person's risk for stroke.
  • history of prior stroke
    The risk of stroke for someone who has already had one is many times that of a person who has not had a stroke.
  • heredity/genetics
    The chance of stroke is greater in people who have a family history of stroke.
Other risk factors of stroke to consider:
  • where a person lives
    Strokes are more common among people living in the southeastern United States than in other areas. This may be due to regional differences in lifestyle, race, cigarette smoking, and diet.
  • temperature, season, and climate
    Stroke deaths occur more often during periods of extreme temperatures.
  • socioeconomic factors
    There is some evidence that strokes are more common among low-income people than among more affluent people.

High folic acid intake may reduce the risk of strokes:

A recent study, which included two decades of following nearly 10,000 American adults, found that people with daily diets that included at least 300 micrograms of folic acid, a B vitamin, cut their risk of stroke by 20 percent, compared with people who ate less than 136 micrograms of folic acid a day. The reduced risk of stroke was associated with higher intake of folic acid among both men and women, regardless of physical activity levels and smoking habits.

Some studies have demonstrated that folic acid lowers levels of homocysteine in the blood. Homocysteine is an amino acid that has been linked to a higher risk of atherosclerosis (hardening of the arteries that can lead to stroke and heart attack).

Foods that contain folic acid include:

  • citrus fruits
  • tomatoes
  • leafy vegetables
  • beans
  • grain products

Wheat flour has been fortified with folic acid since 1998, by order of the US Food and Drug Administration (FDA), to reduce the increased risk of birth defects associated with low-folic acid diets. Always consult your physician for more information.