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. 2025 Sep;10(3):813-821.
doi: 10.1177/23969873241309516. Epub 2025 Jan 2.

Mortality in ischaemic stroke patients without standard modifiable risk factors: An analysis of the Riksstroke registry

James Beharry  1 , Vignan Yogendrakumar  2   3 , Guilherme W F Barros  4 , Stephen M Davis  2 , Bo Norrving  5 , Gemma A Figtree  6   7   8 , Geoffrey Donnan  2 , Mia von Euler  9 , Marie Eriksson  4
Affiliations

Mortality in ischaemic stroke patients without standard modifiable risk factors: An analysis of the Riksstroke registry

James Beharry et al. Eur Stroke J. 2025 Sep.

Abstract

Introduction: Little is known of the long-term prognosis of patients with acute ischaemic stroke in the absence of standard modifiable stroke risk factors (SMoRFs). In acute coronary syndromes, patients without modifiable risk factors have a higher mortality rate. We analysed data from the Swedish Stroke Register to determine survival of patients without SMoRFs following an ischaemic stroke.

Patients and methods: We identified adult patients with first-presentation acute ischaemic stroke between 2010 and 2020. Patients were considered to possess a SMoRF if they had one of: hypertension, diabetes, hyperlipidaemia, atrial fibrillation or an active smoking history. We compared mortality in patients with and without SMoRFs following first-presentation ischaemic stroke using cox regression models. We also assessed the combined endpoint death and dependency (mRS 3-6) at 3 months via logistic regression models.

Results: Of 152,588 patients with ischaemic stroke, hypertension (58.7%) and atrial fibrillation (27.3%) were the most common risk factors. 34,019 patients (22.3%) had no SMoRFs. After a first-presentation ischaemic stroke, patients without SMoRFs had a lower risk of death than patients with one or more SMoRFs (HR 0.58 [95% CI 0.57-0.59]). The absence of SMoRFs was associated with lower odds of death and dependency at 3 months in logistic regression models (OR 0·60 [95% CI 0.58-0.62]).

Conclusion: One in five patients with acute ischaemic stroke had no standard modifiable stroke risk factors. These patients have lower risk of death compared to patients with one or more SMoRFs.

Keywords: Stroke; death; dependency; mortality; risk factors.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SD reports personal fees from Amgen, Boehringer Ingelheim, Medtronic, Abbot, and CSL Behring. BN reports personal fees for DSMB work for Simbec-Orion.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Cumulative incidence curves for risks of a second stroke or death, stratified by SMoRF-status. SMoRF: standard modifiable stroke risk factors.
See this image and copyright information in PMC

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