Etiology of Ischemic Stroke The following are the modifiable risk factors that contribute the most to increased risk of ischemic stroke: Hypertension Cigarette smoking Dyslipidemia Diabetes Insulin resistance (1) Abdominal obesity Excess alcohol consumption Lack of physical activity High-risk diet (eg, high in saturated fats, trans fats, and calories) Psychosocial stress (eg, depression) Heart disorders (particularly disorders that predispose to emboli, such as acute myocardial infarction, infective endocarditis, and atrial fibrillation) Use of certain drugs (eg, cocaine, amphetamines) Hypercoagulability Vasculitis Use of exogenous estrogen Unmodifiable risk factors include the following: Prior stroke Sex Race / ethnicity Older age Family history of stroke The most common causes of ischemic stroke can be classified as Cryptogenic (ie, no clear cardioembolic, lacunar, or atherosclerotic source; the most common classification) Cardioembolism Lacunar infarcts Large-vessel atherosclerosis (the 4th most common cause) Large-vessel atherosclerosis Large-vessel atherosclerosis can affect intracranial or extracranial arteries.