1
Table 1. Assessing the Risk of First Stroke
Recommendations
COR LOE
e use of a risk assessment tool such as the AHA/ ACC CV
Risk Calculator (http://my.americanheart.org/cvriskcalculator)
is reasonable because these tools can help identify individuals who
could benefit from therapeutic interventions and who may not be
treated on the basis of any single risk factor. ese calculators are
useful to alert clinicians and patients of possible risk, but basing
treatment decisions on the results needs to be considered in the
context of the overall risk profile of the patient.
IIa B
Table 2. Genetic Factors
Recommendations
COR LOE
Obtaining a family history can be useful in identifying people who
may have increased stroke risk.
IIa A
Referral for genetic counseling may be considered for patients with
rare genetic causes of stroke.
IIb C
Treatment of Fabry disease with enzyme replacement therapy might
be considered, but has not been shown to reduce the risk of stroke,
and its effectiveness is unknown.
IIb C
Noninvasive screening for unruptured intracranial aneurysms in
patients with ≥2 first-degree relatives with SAH or intracranial
aneurysms might be reasonable.
IIb C
Noninvasive screening may be considered for unruptured intracranial
aneurysms in patients with autosomal-dominant polycystic kidney
disease and ≥1 relatives with autosomal-dominant polycystic kidney
disease and SAH or ≥1 relatives with autosomal-dominant polycystic
kidney disease and intracranial aneurysm.
IIb C
Noninvasive screening for unruptured intracranial aneurysms in
patients with cervical fibromuscular dysplasia may be considered.
IIb C
Pharmacogenetic dosing of vitamin K antagonists may be considered
when therapy is initiated.
IIb C
Noninvasive screening for unruptured intracranial aneurysms in
patients with no more than one relative with SAH or intracranial
aneurysms is NOT recommended.
III C
Screening for intracranial aneurysms in every carrier of autosomal-
dominant polycystic kidney disease or Ehlers-Danlos type IV
mutations is NOT recommended.
III C
Genetic screening of the general population for the prevention of a
first stroke is NOT recommended.
III C
Genetic screening to determine risk for myopathy is NOT
recommended when initiation of statin therapy is being considered.
III C
Diagnosis
