Underrecognized Stroke Risk Factors in Focus at ISC 2026

Overlooked or underestimated risk factors may warrant more consideration in stroke prevention and epidemiology, according to new research presented during an oral abstract session at the International Stroke Conference (ISC) 2026 in New Orleans, Louisiana.

One abstract highlighted how crucial regular dental care is in reducing the risk of secondary ischemic stroke among patients with heart disease, showing a 39% lower risk among individuals who went to the dentist regularly.¹

Carly Pikel, a first-year medical student and study author, first noted that oral infection and gum disease are arguably the most prevalent modifiable risk factors for stroke worldwide, affecting about 3.5 billion people.² Together, these are more common than the typical “big 5” modifiable risk factors of hypertension, obesity, high low-density lipoprotein cholesterol, tobacco use, and diabetes, Pikel said.

However, the US Preventive Services Task Force concluded that there is not enough evidence to include oral health care as a preventive measure for stroke, and the 2021 Secondary Stroke Prevention guidelines do not address it. Still, research by Pikel’s mentor, Souvik Sen, MD, and others, has shown links between periodontal disease, oral inflammation, and stroke.³

The relationship between oral health behaviors—brushing, flossing, and especially dental visits—and secondary ischemic stroke is not as clear, which prompted the research presented at ISC 2026. Pikel and colleagues used data from the Atherosclerosis Risk in Communities (ARIC) study to explore this relationship in individuals who had a history of cardiovascular events.

Patients were asked oral care questions at visit 4 and were stratified into regular (n = 637) or episodic (n = 587) dental care groups and followed for 25 years for secondary stroke. Regular care was defined as visiting the dentist at least once per year, whereas episodic use was defined as utilizing dental care only when there was an issue.

Cox regression models demonstrated an association between regular dental care use and reduced risk of secondary ischemic stroke (HR, 0.56; 95% CI, 0.40-0.78; P < .001). After adjusting for demographics, vascular risk factors, oral hygiene practices, and medication use, the association was still significant (adjusted HR, 0.61; 95% CI, 0.40-0.93; P = 0.02).

“This highlights that oral health care is a very actionable yet still underrecognized component of secondary stroke prevention,” Pikel said, emphasizing the need for collaboration between physicians and dental care providers.

Hyperthyroidism and Cerebral Venous Sinus Thrombosis Risk in Women

Cerebral venous sinus thrombosis (CVST), a rare type of stroke that is more common in women, is linked with significant mortality and a range of risk factors, Daniela Zambrano, MD, MPH, neurologist at the University of Vermont Medical Center and assistant professor of neurology at the University of Vermont Larner College of Medicine, explained. But one potentially overlooked risk factor, she said, is hypothyroidism—another condition that is more common in women.

Using data from women aged 18 to 60 years in the National Inpatient Sample, the largest publicly available inpatient all-payer database, she and Jason Neal, MD, of Baylor Scott and White Health in Temple, Texas, aimed to determine whether hyperthyroidism is linked with CVST. They used a few models: model 1 was adjusted for age, model 2 for age and race/ethnicity, and model 3 was fully adjusted for demographic characteristics and comorbidities.

Among the 6,780,445 women included in the study, those with vs without hyperthyroidism had a 2-fold higher risk of CVST in the crude analysis, with findings remaining significant after adjusting for risk factors such as age, race/ethnicity, pregnancy, hormonal therapy, and comorbidities. Women with hyperthyroidism had an 82% (HR, 1.82; 95% CI, 1.05-3.13) greater likelihood of CVST compared with women who did not have hyperthyroidism in the fully adjusted model. Zambrano noted limitations of the study, which included its cross-sectional nature, which limits the determination of temporality and causation.

“These findings are similar to data from deep vein thrombosis and pulmonary embolism literature, which reveal higher odds of deep vein thrombosis and pulmonary embolism in women with hyperthyroidism,” Zambrano said.

The studies together highlight that not only is the stroke treatment landscape changing, but so is the landscape of stroke epidemiology research.

References

1. Pikel K, Hall A, Osborn M, Moss K, Rosamond WD, Sen S. Regular dental care and reduced risk of secondary ischemic stroke in patients with cardiovascular disease. Presented at: International Stroke Conference 2026; February 4-6, 2026; New Orleans, LA. Abstract A009.

2. Global oral health status report: towards universal health coverage for oral health by 2030. World Health Organization. November 18, 2022. Accessed February 5, 2026. https://www.who.int/publications/i/item/9789240061484

3. Sen S, Redd K, Trivedi T, et al. Periodontal disease, atrial fibrillation, and stroke. Am Heart J. 2021;235:36-43. doi:10.1016/j.ahj.2021.01.009

4. Zambrano DD, Neal J. Hyperthyroidism: an overlooked risk factor for cerebral venous sinus thrombosis (CVST) in women. Presented at: International Stroke Conference 2026; February 4-6, 2026; New Orleans, LA. Abstract A013.