Risk factors
General risk factors
There are various risk factors that increase the probability of someone having a stroke:
High "bad" blood cholesterol
Cholesterol is a necessary fat in the body that is used to make essential vitamins, hormones and each of the millions of cells inside of our bodies. We could not live without cholesterol. Since cholesterol cannot mix with blood, it needs to be carried in blood by a molecule known as a lipoprotein. There are two types of cholesterol: high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol. HDL, or "good," cholesterol, absorbs excess cholesterol and sends it to the liver, which excretes it from the body. LDL, or "bad," cholesterol does not absorb excess cholesterol and allows fatty deposits to form plaques in blood vessels. Therefore, high levels of LDL cholesterol and low levels of HDL cholesterol (for men) can increase one's risk of having a stroke.
Diabetes
Both type I and type II diabetes are risk factors for stroke. Please take control of your blood sugar levels in order to lower your risk. Type II diabetes also increases "bad" (LDL) cholesterol levels and decreases "good" (HDL) cholesterol levels, which is another stroke risk factor [1].
High blood pressure
The scientific name for this is hypertension. It is one of the leading risk factors for stroke, so know what your blood pressure is and how to get it down. A link to a guide from the American Stroke Association can be found on the "Lifestyle" page.
Obesity
Obesity or excessive body weight is very closely associated with diabetes, high cholesterol, high blood pressure, and physical inactivity. It is not being obese that is the risk factor, but a majority of the time, being obese goes hand in hand with all of these other risk factors that increase the risk of having a stroke. Even losing a small amount of weight can go a long way to decreasing the chance of ever having a stroke.
Cardiac problems
There are many different cardiac problems that increase risk of having a stroke. A non-exhaustive list includes problems such as carotid artery disease, peripheral artery disease, atrial fibrillation (a special type of irregular heartbeat), coronary heart disease, heart failure, and others.
Smoking
Smoking has been linked to many different health disorders. For stroke specifically, the nicotine and carbon monoxide found in cigarettes and other smoking devices has been linked to increased stroke incidence [2]. The nicotine increases heart rate and blood pressure while carbon monoxide reduces how much oxygen gets to vital organs like the brain. The risk is even greater when combined with the use of birth control pills. Quitting smoking will lower the risk of having a stroke and the risk of having other health problems.
Inherited genetic disorders
There are inherited diseases like Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), a genetic disorder which leads to the thickening of blood vessel walls and increases the chances of blood clotting, and other blood clotting disorders [3]. These increase the chance of someone having a stroke.
Excessive use of alcohol and drugs
An excessive use of drugs, such as cocaine or methamphetamines, can greatly increase one's chances of having an aneurysm, which can lead to hemorrhagic stroke once it ruptures. Alcohol abuse can also increase risk of having a stroke. Please find a local support group or consult your doctor if you have any trouble with excessive use of these substances.
Age
As you get older, it is more likely that you will suffer a stroke, whether or not you have a great lifestyle. Since this is out of your control, it is best not to worry about it and focus on lifestyle factors that you can control. However, even though it is more common for people over 65 to have a stroke, it still happens quite often to adults and even children who have one or more of these risk factors.
No exercise (physical inactivity)
A lack of regular exercises can increase one's chances of being overweight, developing heart problems, as well as high blood cholesterol and blood pressure. All of these are risk factors for any type of stroke.
COVID-19
Even with all of the advances that have been made to understand COVID-19, there are still a lot of things we do not know about it, in both the short and long term. COVID-19 increases risk of blood clotting in young individuals [4]. COVID-19 has also been associated with increased risk of cryptogenic stroke in both old and young patients [5]. Day by day, there is more evidence mounting to suggest that COVID-19 affects every organ system. Please wear a mask, socially distance wherever possible and strongly consider vaccination when the appropriate time comes. It will not only save you, your family, and your loved ones now, but may save them from neurological issues in the future.
Risk factors for Latino population
Of course, just because someone is Latino does not mean that they are more likely to have a stroke. On the other hand, it is pretty apparent that medical discrimination inherent within our healthcare system and a lack of quality information in Spanish about living a healthy life in United States plays a huge role.
While the majority of Latinos in the U.S. are covered by some form of healthcare insurance, the latest statistics from the United States Center for Disease Control (CDC) show that 20.1% of Hispanic or Latino people under the age of 65 in the U.S. do not have access to health insurance compared to 7.8% of White non-Hispanic people [6-7]. For some obscure reason, the CDC excludes Mexican Americans from the Latino category, but includes Hispanics. The latest data show that 22.1% of Mexican Americans under the age of 65 do not have access to health insurance [8]. With more limited access to healthcare compared to the majority of the U.S. population, some Latinos do not have access to proper treatment options nor the proper education about how to avoid or prevent certain diseases or events such as stroke.
Another important factor of access to insurance and quality health care is median household income. For the U.S. Latino population, the median household income is $56,113 compared to $76,057 for the White population [9]. Even though the median household income has increased, the numbers are more likely to be deflated, due to the massive job losses during the COVID-19 pandemic that have primarily affected the Black and Latino populations, according to the Economic Policy Institute [10].
An important distinction to make is how a higher percentage of Latinos have one or more stroke risk factors due to reasons such as institutional or language barriers. According to the latest statistics from the CDC, 41.2% of Hispanic or Latino men and 48.4% of Hispanic or Latina women over 20 are obese compared to 36.9% of white men and 38.8% of white women [6-7]. Additionally, 44.4% of Mexican American men and 51.3% of Mexican American women over 20 are obese. The U.S. Latino population also has one of the highest rates of diabetes, uncontrolled high blood pressure, and exercise inactivity [11]. This, combined with some of the barriers that the Hispanic and Latino population have to face, illustrates that compared to the majority of the population, they are more at risk of having a stroke.
Risk factors for Latina women
In general, women are much more likely to have a stroke and to die from it then men [12]. Latina women specifically have one of the lowest median survival age of all the demographics: the median survival age is 77 years whereas the age for white women is 79 years and for asian women 86 years [13]. Additionally, Latina women are more likely to be caregivers to someone who had a stroke. One study that focused on the health of obese Latina women caregivers showed that they were more likely to have risk factors for stroke, such as high blood cholesterol levels and high blood pressure, and less likely to self-report them [14]. Of course, this is just a singular study that does not represent the entire population, but it does demonstrate that some Latina women are more at risk to have a stroke.
The majority of Latina women who immigrated to the United States report having chronic illnesses, such as diabetes, and mental health problems, such as depression and anxiety [15]. Immigration concerns have also been shown to have a negative impact on health despite the actual status of their immigration [15]. Overall, Latina women may be more at risk of having a stroke due to situational circumstances as well as institutional and language barriers.
References
[1] https://www.cdc.gov/cholesterol/ldl_hdl.htm
[3] https://www.ninds.nih.gov/Disorders/All-Disorders/CADASIL-Information-Page
[4]Fara MG, Stein LK, Skliut M, Morgello S, Fifi JT, Dhamoon MS Macrothrombosis and stroke in patients with mild Covid-19 infection. J Thromb Haemost. 2020; (published online May 28. https://doi.org/10.111/jth.14938)
[5] Fifi, J. T., & Mocco, J. (2020). COVID-19 related stroke in young individuals. The Lancet Neurology, 19(9), 713-715.
[6] https://www.cdc.gov/nchs/fastats/hispanic-health.htm
[7] https://www.cdc.gov/nchs/fastats/white-health.htm
[8] https://www.cdc.gov/nchs/fastats/mexican-health.htm
[9] https://www.census.gov/data/tables/2020/demo/income-poverty/p60-270.html
[11] Martinez, M., Prabhakar, N., Drake, K., Coull, B., Chong, J., Ritter, L., & Kidwell, C. (2016). Identification of barriers to stroke awareness and risk factor management unique to Hispanics. International journal of environmental research and public health, 13(1), 23.
[13] Paz K, Massey KP (2016) Health Disparity among Latina Women: Comparison with Non-Latina Women. Clin Med Insights Womens Health 9:71–74.
[14] Ifejika NL, Bhadane M, Cai C, Noser EA, Savitz SI (2019) Cluster Enrollment: A Screening Tool for Stroke Risk Factors in Minority Women Caregivers. J Natl Med Assoc 111:281–284.
[15] Luque JS, Soulen G, Davila CB, Cartmell K (2018) Access to health care for uninsured Latina immigrants in South Carolina. BMC Health Serv Res 18:310.