Research is needed to validate risk assessment tools across age, sex, and race/ethnic groups; to evaluate whether any of the more recently identified risk factors add to the predic- tive accuracy of existing scales; and to determine whether the use of these scales improves primary stroke prevention. Assessing the Risk of First Stroke: Recommendations 1. The 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. These 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 (Class IIa; Level of Evidence B). Generally Nonmodifiable Risk Factors and Risk Assessment Age The cumulative effects of aging on the cardiovascular sys- tem and the progressive nature of stroke risk factors over a prolonged period substantially increase the risk of ischemic stroke and intracerebral hemorrhage (ICH). An analysis of data from 8 European countries found that the combined risk of fatal and nonfatal stroke increased by 9%/y in men and The incidence of ICH increases with age from <45 years to >85 years, and the incidence rates did not decrease between 1980 and 2006.27 Disturbing trends have been observed in the risk of stroke in younger individuals. In Greater Cincinnati/Northern Kentucky, the mean age of stroke decreased from 71.2 years in 1993 to 1994 to 69.2 years in 2005 because of an increase in the proportion of stroke in Table 2. 