Identify the strongest modifiable risk factor for stroke and the strongest nonmodifiable risk factor.

• A. Smoking; age
• B. Hyperlipidemia; sex
• C. Atrial fibrillation; race
• D. Hypertension; age

Answer: (D)

Hypertension is the strongest modifiable risk factor for stroke because high blood pressure damages cerebral vessels over time, promotes both large-vessel atherosclerosis and small-vessel disease, and raises the risk of both ischemic and hemorrhagic strokes. Importantly, lowering blood pressure repeatedly lowers stroke incidence, which is why controlling hypertension is the most powerful preventive strategy.

Age is the strongest nonmodifiable risk factor because stroke risk increases with aging due to cumulative vascular changes and longer exposure to other risk factors; you can’t change your age, but it profoundly influences overall risk.

Other factors like smoking or high cholesterol contribute to risk, and atrial fibrillation is a major stroke risk when present, but hypertension remains the dominant modifiable factor, while age remains the dominant nonmodifiable factor.