New Stroke Prevention Guidelines: A Quick and Easy Guide

Helmi L. Lutsep, MD; Bret S. Stetka, MD

Disclosures

January 16, 2015

In This Article

Genetic Factors

Family history is useful.

Rare genetic causes of stroke: consider genetic counseling.

Fabry disease: consider enzyme replacement therapy; note that effectiveness is unknown.

≥2 first-degree relatives with subarachnoid hemorrhage (SAH) or intracranial aneurysms: consider noninvasive screening for unruptured intracranial aneurysms.

Autosomal dominant polycystic kidney disease (ADPKD) and ≥1 relatives with ADPKD and SAH, ≥1 relatives with ADPKD and intracranial aneurysm: consider noninvasive screening for unruptured intracranial aneurysms.

Cervical fibromuscular dysplasia: consider noninvasive screening for unruptured intracranial aneurysms.

Consider pharmacogenetic dosing of vitamin K antagonists when therapy is initiated.

Noninvasive screening for unruptured intracranial aneurysms is not recommended in patients with no more than 1 relative with SAH or intracranial aneurysm.

Screening for intracranial aneurysms in every carrier of autosomal dominant polycystic kidney disease or Ehlers-Danlos type IV mutations is not recommended.

Genetic screening of the general population is not recommended.

Genetic screening to determine myopathy risk is not recommended when considering statin therapy.

The Bottom Line: Although genetic causes of stroke—including those, for example, related to age and race—are still generally nonmodifiable risks because gene therapy is not yet available, providing counseling for such diseases as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukencephalopathy (CADASIL) can be helpful to families with that disorder. Enzyme replacement therapy is available for Fabry disease, in which lipid metabolism is impaired, potentially increasing cardiovascular risk. Finally, identification of potential stroke risks, such as unruptured aneurysms, can be sought in selected instances.

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