Abstract
The Framingham Stroke Risk Profile (FSRP) is a validated model for predicting 10-year ischemic stroke risk in middle-aged adults, yet has not been demonstrated to consistently translate in older populations. This is a systematic review of independent risk factors measured among > 65 year olds, with subsequent first ischemic stroke, using PRISMA guidelines. We appraised peer-reviewed publications that included participants > 65 years old at risk assessment. Combined with other criteria, results were abstracted from 28 papers reporting six types of stroke risk factors: Serologic/Diagnostic, Conventional, Psychosocial, Genetic, Cognitive, and Antibiotic use. These studies demonstrated levels of serum androgens, C-reactive protein, and advanced glycation endproducts; thrombin generation; left ventricular mass; depressive symptoms; phosphodiesterase 4D single nucleotide polymorphisms; coagulation factor XII gene; peak thrombus generation; and lower cognitive functioning were independent risk factors for ischemic stroke in older adults. Plasma adipokines, free fatty acids and antibiotic use did not predict ischemic stroke. Purpose in life and APOEε2 allele were protective for ischemic stroke. This systematic review provides evidence of risk and protective factors for ischemic stroke in older cohorts that are not included in the FSRP. Further studies are needed to understand whether these factors are important enough to comprise a risk score.
Highlights
Stroke is the 5th leading cause of death [1] and the leading cause of long-term disability in the United States [2]
Excluded were: 367 articles that did not focus on the elderly (
After adjusting for body mass index (BMI) and other ischemic stroke risk factors, resistin was the only adipokine found to predict the odds of ischemic stroke
Summary
Stroke is the 5th leading cause of death [1] and the leading cause of long-term disability in the United States [2]. The number of incident strokes is predicted to more than double between the years 2010 to 2050, with most strokes occurring in adults over the age of 75 years [3]. This age group (>75 years) experiences more hospitalization stays and higher mortality [4] post-stroke. Despite these nuances of stroke risk and stroke outcomes at older ages, risk factors specific to this age group have not been wellstudied. Accurate risk assessment tools and interventions to reduce stroke risk among older adults are lacking
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