Stroke in the elderly: Risk factors and some projections

Stroke is the third leading cause of death in the U.S. and is associated with enormous personal and economic cost. Stroke mortality, however, may be declining in the face of a stable incidence rate suggesting a decrease in the case fatality rate; disability remains high. Age is the most powerful nonmodifiable risk factor for stroke, along with ethnicity and familial predisposition. The most significant modifiable risk factor for ischemic and hemorrhagic stroke is hypertension, whereas atrial fibrillation is the most important cardiac cause of stroke. Diabetes and hyperlipidemia are also powerful, potentially modifiable risk factors. Obstructive carotid atherosclerosis, under proper clinical circumstances, can also be viewed as a modifiable risk factor for stroke. With the aging of the U.S. population, an increase in the number of stroke deaths and surviving disabled can be anticipated. The National High Blood Pressure Education Program (NHBPEP) can have a dramatic effect on age adjusted mortality from stroke. Hypertension control is the key to reducing the stroke burden of populations in the first quarter of the twenty first century.