HTN: Most important modifiable risk factor for both ischemic and hemorrhagic stroke (sevenfold increased risk). Lower rates of recurrent stroke with lower blood pressures (BPs). Most recently, the BP-reduction component of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial showed that targeting a systolic BP (SBP) <130 mmHg (compared to 130–149 mmHg) was likely to reduce stroke by 20% and intracerebral hemorrhage (ICH) by two-thirds (Benjamin et al., 2018).

History of TIA/prior stroke: Approximately 5% of patients with TIA will develop a stroke within 1 month and approximately 14% within 1 year if untreated. After a TIA, the 90-day risk of stroke is 3% to 17.3% and is highest within the first 30 days (Coull et al., 2004; Johnston et al., 2003).

Heart disease:Congestive heart failure (CHF) and coronary artery disease (CAD) increase risk by twofold.Valvular heart disease and arrhythmias increase risk of embolic stroke.

Atrial fibrillation (AF): Dominant risk factor for stroke, independently increasing risk fivefold throughout all ages (Benjamin et al., 2018).

The percentage of strokes attributable to AF increases from 1.5% at 50 to 59 years of age to 23.5% at 80 to 89 years of age (Benjamin et al., 2018).

AF increased with age in the stroke population (2% in age <50 years old, 15% with ages in 70s, 28% with ages in 80s, 40% in ages >90 years old; Jørgensen et al., 1996).

AF was associated with increased age, CAD, previous stroke, and increased SBP but was not associated with gender, diabetes mellitus, or previous TIA (Jørgensen et al., 1996).

Diabetes: Twofold increase in risk. Duration of diabetes for more than 3 years was associated with an increased rate of ischemic stroke compared with a duration of <3 years (Benjamin et al., 2018).

Cigarette smoking: Cigarette smoking is a risk factor for ischemic stroke and subarachnoid hemorrhage (SAH). Current smokers have a two to four times increased risk of stroke compared with nonsmokers or those who have quit for >10 years (Benjamin et al., 2018).

Carotid stenosis (and carotid bruit): Carotid endarterectomy (CEA) is of some benefit to prevent stroke in patients with 50% to 69% symptomatic stenosis (absolute risk reduction 4.6%) and highly beneficial in patients with 70% to 99% stenosis (absolute risk reduction 16.0%).

Ethyl alcohol (ETOH) abuse/cocaine use: <2 drinks per day relative risk 0.51; >7 drinks per day relative risk 2.96 (Sacco et al., 1999).

High-dose estrogens (birth control pills): Considerable increased risk when linked with cigarette smoking.

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