Diseases & Longevity · File 10

Stroke. 90% of the risk is modifiable years before the event.

Stroke is the second global cause of death and the third cause of disability worldwide. INTERSTROKE study (Lancet 2010) demonstrated that 10 modifiable factors explain 90% of population risk — hypertension, dyslipidemia, smoking, diabetes, obesity, physical inactivity, diet, alcohol consumption, stress, and depression. That is the window where longevity medicine operates.

Why stroke is a trajectory disease, not an event

The stroke appears as an acute event — minutes, hours — but its biology builds over decades. Carotid atherosclerosis, silent atrial fibrillation, endothelial damage from sustained hypertension, dyslipidemia with elevated ApoB, small vessel disease from chronic inflammation — all of this precedes the stroke by 20 or 30 years. The event is the consequence, not the problem.

INTERSTROKE (O'Donnell et al., Lancet 2010, n=6,000 cases vs 6,000 controls in 22 countries) quantified that 10 modifiable factors explain 90% of population risk. Hypertension alone explains ~35%. That is why a longevity clinic measures cerebrovascular risk decades before the event — and why a well-informed neurologist refers pre-stroke patients to that evaluation.

Stroke is not an accident. It is the visible consequence of 20 years of biology that the conventional system fails to fully measure.
INTERSTROKE · Lancet · 2010

The global weight, in numbers

The stroke burden was counted in global cohorts — GBD, INTERSTROKE, Framingham. These are the evidence points that support the clinical picture.

  • Global burden

    #2 muerte / #3 discapacidad

    Stroke is the second cause of death worldwide (approx. 6.5 million per year) and the third cause of years lived with disability. Growing dominance in middle-income countries.
    — GBD 2019; WHO GHE 2020

  • 10 factors explain 90%

    INTERSTROKE n=12,000

    HTN, dyslipidemia, smoking, DM, abdominal obesity, diet, inactivity, alcohol, psychosocial stress, and cardiac causes (AF) explain 90% of population stroke risk. HTN alone explains ~35%.
    — O'Donnell et al., Lancet 2010

  • AF and stroke risk

    ×5 riesgo embólico

    Atrial fibrillation multiplies ischemic stroke risk by 5 and overall mortality by 2. A significant proportion is silent — only detected with prolonged ECG monitoring.
    — Chugh et al., Circulation 2014

  • Mortality and recurrence

    ~25% a 30 días

    30-day mortality after a major stroke is ~25%, and 5-year recurrence exceeds 25% without intervention on risk factors. The biology of the second stroke is the first one's, less controlled.
    — GBD 2019; Framingham Heart Study

Chap. 03 · Post-stroke disability

Impact on quality of life post-event

Stroke does not kill most who suffer it — but it rewrites their functional capacity, autonomy, and longevity trajectory sustainably.

  • Severe functional loss

    SIS / Barthel ↓↓

    Stroke Impact Scale (SIS) and Barthel Index show severe and persistent functional capacity losses at 6 and 12 months post-event — particularly in motor function, language, and social participation.
    — Duncan PW, Stroke 1999

  • Post-stroke depression

    ~30% de pacientes

    Approximately 30% of patients develop post-stroke depression in the first year — independent predictor of worse functional recovery, higher mortality, and greater recurrence risk.
    — Hackett et al., Lancet 2014

  • Vascular cognitive impairment

    Riesgo demencia 2–3×

    After a major stroke, dementia risk multiplies by 2-3. Vascular dementia and small vessel disease are neurodegenerative axes shared with the cerebrovascular trajectory.
    — Pendlebury & Rothwell, Lancet Neurol 2009

  • Work loss and dependence

    Top causa discapacidad activa

    Stroke is one of the main causes of involuntary work retirement in adults 50-65. Family and social economic burden accumulates years of disability — Eriksen 2025 effect amplified in the worst health score.
    — Eriksen et al., Sci Rep 2025

What we don't offer — and what we do

Wellness Care does not manage acute stroke. Thrombolysis, mechanical thrombectomy, stroke unit management, and post-event rehabilitation are the neurologist's and hospital's responsibility. What we do is what the conventional model rarely does well before the event: measure and modulate the 10 factors explaining 90% of risk.

We evaluate patients with subjective cardiovascular concern, family history, poorly controlled HTN, or suspected silent atrial fibrillation through advanced biomarker panel — extended lipid profile (ApoB, Lp(a)), HRV, hsCRP, fibrinogen, endothelial function. We design individualized protocols acting on modifiable factors. Intervention is done in coordination with the cardiologist or neurologist when clinically indicated.

We don't promise to prevent stroke. What we do hold: 90% of risk is modifiable, and that is measured and worked on years before the event.
How we measure it

How cerebrovascular risk
is evaluated at Wellness Care

Before proposing any intervention: we measure. Stroke risk assessment is built from four convergent layers — cardiovascular, metabolic, inflammatory, and autonomic.

Advanced biomarkers

21 specialized panels across 8 clinical categories — biological age, inflammaging, metabolic profile, functional hormonal, microbiota. The quantitative layer.

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Functional medicine

Shared root causes — mitochondrial dysfunction, inflammaging, neuroendocrine dysregulation — before organ pathology.

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Bioregulatory medicine

Autonomic regulation, HRV, stress response. The functional trajectory that precedes clinical diagnosis.

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The Longevity Program

How this assessment integrates into the full program — from initial valuation to individualized protocol design under medical judgment.

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Featured evidence

Key evidence supporting this approach

Four publications structuring the stroke conversation in longevity medicine — INTERSTROKE, Framingham, quality of life data, and neurodegenerative comorbidity.

«10 factores de riesgo modificables explican el 90% del riesgo poblacional de ictus. La hipertensión sola explica aproximadamente el 35%.»
Lancet · 2010 · n=12,000
O'Donnell et al., Lancet 2010
INTERSTROKE — global case-control
«La fibrilación auricular multiplica por 5 el riesgo de ictus isquémico — y una proporción significativa es silente, lo que justifica monitorización ECG prolongada en pacientes de alto riesgo.»
Circulation · 2014
Chugh et al., Circulation 2014
Epidemiología FA / ictus
«Tras un ictus, el riesgo de demencia se multiplica por 2-3. La biología cerebrovascular y la neurodegenerativa convergen en la enfermedad de pequeño vaso.»
Lancet Neurol · 2009
Pendlebury & Rothwell, Lancet Neurol 2009
Demencia vascular post-ictus

Frequently asked questions about stroke

The most recurrent questions about stroke, the 10 INTERSTROKE factors, and how longevity medicine acts on cerebrovascular risk years before the event.

01

Is stroke hereditary?

There is a genetic component — family history of early stroke increases risk — but most of the risk is modifiable.

INTERSTROKE showed that 10 non-genetic factors explain 90% of population risk.

The useful conversation is: «what of your biological trajectory can you measure and modulate?», not «do I have the gene?».

02

Which biomarkers measure cerebrovascular risk?

In longevity medicine we evaluate:

· Advanced lipid profile — ApoB, Lp(a), non-HDL
· Inflammatory profile — hsCRP, fibrinogen, IL-6
· Endothelial function (when available)
· HRV and ambulatory BP (ABPM)
· Prolonged cardiac rhythm in AF suspicion
· Metabolic profile — HbA1c, insulin
· Coagulation

The pattern guides — not a single biomarker.

03

Does well-controlled hypertension eliminate the risk?

It reduces it significantly — HTN is the highest-weight modifiable factor — but does not eliminate it.

Residual risk depends on:

· The other 9 factors INTERSTROKE
· Prior duration of poorly controlled HTN (vascular memory effect)

Optimal control (<130/80 in high-risk patients, per SPRINT 2015) requires ambulatory monitoring, not just office measurement.

04

When to suspect silent atrial fibrillation?

Suspect silent AF in:

· Adults >65 with intermittent palpitations
· Unexplained exertional dyspnea
· Cryptogenic ischemic stroke
· Moderate-severe sleep apnea
· Subclinical hyperthyroidism
· Heart failure of uncertain etiology

Prolonged ECG monitoring (Holter 7-14 days, patch, or implantable when indicated) significantly changes detection rate vs baseline ECG.

05

Is inflammation really an independent risk factor?

Yes.

Multiple cohorts have shown that elevated hsCRP predicts cardiovascular and cerebrovascular events even in patients with controlled LDL:

· JUPITER 2008 — Rosuvastatin in elevated hsCRP
· CANTOS 2017 — Canakinumab (anti-IL-1β) reduces CV events in elevated residual hsCRP post-MI

Proof of concept for the vascular inflammaging theory — one of the central targets of longevity medicine.

06

When should I consult for suspected cerebrovascular risk?

A structured assessment is worthwhile if you have:

· Family history of early stroke (<60)
· HTN poorly controlled or long-standing
· Dyslipidemia with elevated ApoB or Lp(a)
· Diabetes
· Known or suspected AF
· Moderate-severe sleep apnea
· Transient ischemic attack (TIA)

The assessment does not replace cardiology — it complements it with profiles the conventional system rarely orders in general consultation.

The 90% modifiable

Stroke is not an accident — it is the visible consequence of 20 years of biology the conventional system fails to fully measure.

Measure the 10 INTERSTROKE factors, evaluate advanced lipid and autonomic profile, coordinate with cardiology and neurology when clinically indicated — that is what a serious longevity clinic does in cerebrovascular risk.

Family history or cerebrovascular risk factors?

Book a comprehensive stroke risk assessment

We evaluate cardiovascular and metabolic profile (advanced lipids, ApoB, Lp(a), hemodynamics, cardiac rhythm), inflammatory profile (hsCRP, fibrinogen), family history, and specific biomarkers. The assessment does not replace cardiology or neurology — it complements them with the longevity view.

Book cerebrovascular assessment