Stroke: Risk Factors, Epidemiology 🧠

 Hey future clinicians! Let’s dive deeper into stroke—a leading cause of morbidity and mortality worldwide. Understanding risk factors, pathophysiology, and epidemiology is key to prevention and management. Here’s a breakdown:

🔎 What is a Stroke?

A stroke occurs when blood flow to the brain is interrupted, either due to a blockage (🛑 ischaemic stroke, ~85%) or bleeding (🩸 haemorrhagic stroke, ~15%). This can lead to brain cell death and lasting neurological deficits.

⚠️ Risk Factors for Stroke

Stroke risk factors can be divided into modifiable and non-modifiable. Let’s explore them with a touch of pathophysiology 🩻

🧬 Non-Modifiable Risk Factors

• 👴 Age: Risk increases with age due to vascular aging, including arterial stiffening and endothelial dysfunction.
• 🚻 Gender: Men are at higher risk, but women tend to have worse outcomes due to hormonal changes (e.g., menopause) and longer life expectancy.
• 🌍 Race/Ethnicity: Higher risk in certain groups due to genetic predispositions (e.g., sickle cell disease in African populations) and socioeconomic factors.
• 👨‍👩‍👧 Family History: Genetic polymorphisms (e.g., coagulation factors, lipid metabolism) can increase susceptibility.

💡 Modifiable Risk Factors

• 📈 Hypertension: Chronic high BP damages arterial walls, leading to atherosclerosis and increasing the risk of vessel rupture or occlusion.
• 💓 Atrial Fibrillation: Irregular heart rhythms cause blood stasis, leading to clot formation that can embolise to the brain.
• 🍬 Diabetes Mellitus: Hyperglycaemia accelerates atherosclerosis and causes endothelial dysfunction, increasing the risk of small vessel disease.
• 🥑 Hyperlipidaemia: High LDL → plaque formation 🏗️, low HDL → reduced lipid clearance 🚫.
• 🚬 Smoking: Nicotine & toxins → endothelial injury, inflammation, and hypercoagulability.
• ⚖️ Obesity & Physical Inactivity: Adipose tissue releases pro-inflammatory cytokines, contributing to atherosclerosis & insulin resistance.
• 🍷 Excessive Alcohol Use: Chronic heavy drinking → high BP, cardiomyopathy → increased stroke risk.
• 😴 Sleep Apnoea: Intermittent hypoxia → oxidative stress & sympathetic activation → hypertension & atherosclerosis.

📊 Epidemiology of Stroke

🌍 Global Burden:

Stroke is the 2nd leading cause of death worldwide and a major cause of disability.

~15 million people suffer a stroke annually; 1 in 4 adults over 25 will have a stroke in their lifetime.

Australian-Specific Data

🩸 Incidence: In 2023, 45,785 Australians experienced a stroke (⏳ 1 stroke every 11 minutes). 34,793 were first-ever strokes.

📌 Prevalence: ~440,481 stroke survivors in Australia, with higher prevalence in males (244,756) vs females (195,725).

👶 Age Distribution: 1 in 4 strokes occur in people under 65, challenging the perception that stroke only affects the elderly.

🌏 Regional Disparities: Australians in regional areas are 17% more likely to suffer a stroke than those in metro areas.

💰 Economic Impact:

Estimated $15.7 billion lifetime cost.

$9 billion in annual costs (healthcare, lost productivity, informal care).

📈 Projections: Without intervention, stroke numbers will rise to 72,000 annually by 2050.

🏥 Clinical Pearls: What You Need to Know!

🔹 TIA ("mini-stroke") = Stroke warning sign! A transient ischaemic attack (TIA) resolves within 24 hours but indicates high stroke risk—don't ignore it! 🚨

🔹 Ischaemic stroke? Consider thrombolysis (if within 4.5 hours) or thrombectomy (if within 24 hours). 🏃‍♂️💉

🔹 FAST test: 🚑 Face droop, Arm weakness, Speech difficulty, Time to call 000—Act FAST! ⏳

❓ Why Does This Matter?

As future physicians, you’ll play a critical role in:

• ✅ Primary prevention (managing risk factors).
• ✅ Acute management (think FAST! 🚨).
• ✅ Rehabilitation & secondary prevention (reducing recurrence).

💬 Discussion Question: What’s one intervention you’d prioritise to reduce stroke risk in your future patients? Let’s hear your thoughts! 👇

#MedEd #StrokeAwareness #Neurology #FutureDoctors