Cerebral ischemia: new risk factors.

Stroke is a disease with well-defined modifiable risk factors such as arterial hypertension, smoking, diabetes, hyperlipidemia and atrial fibrillation. The need of new risk factors is based on the fact that only half the cardiovascular disease risk is explained by conventional risk factors. Inflammatory markers, infection, homocysteine and sleep-disordered breathing rank as the four most important new risk factors in cerebral atherosclerosis. C-reactive protein is the inflammatory marker that has been most thoroughly studied. Elevated concentrations of C-reactive protein increase the risk of heart disease and thromboembolic stroke in men and women. The role of Chlamydia pneumoniae is still controversial. Influenza vaccination is a simple and effective preventive measure against stroke. Despite the potential relationship between homocysteine and stroke, we should wait to the results of the ongoing trials to know if the reduction of homocysteine levels with vitamin therapy is of clinical benefit. Sleep-disordered breathing is a potential new risk factor with an effective therapy. Neurologists should not forget to look for sleep disorders in their stroke patients and probably manage them with breathing therapy from the acute phase.