Response by Aigner et al to Letter Regarding Article, “Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults”

IntroductionWorldwide, 2 million patients aged 18–50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.Methods and analysisThe Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18–50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Ethics and disseminationEthical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

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Abstract WMP49: Disparities in Rising Incidence of Stroke in Adults Younger Than 65

Stroke ◽

10.1161/str.51.suppl_1.wmp49 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Erica Jones ◽

Kristie Chu ◽

Anjail Sharrief ◽

Sean Savitz ◽

Farhaan Vahidy

Keyword(s):

Risk Factors ◽

Young Adults ◽

Stroke Risk ◽

Stroke Incidence ◽

Stroke In Young Adults ◽

Hospitalization Rates ◽

Increased Risk ◽

Asian Pacific ◽

Increase In Risk ◽

Stroke In Young

Introduction: Increased incidence of stroke in young adults has been attributed to rising prevalence of known stroke risk factors such as hypertension. Our aim is to identify young adult demographic groups most in need of clinical and public health intervention to prevent future increases in stroke incidence. Methods: We performed retrospective analyses on hospitalization data from the National Inpatient Sample (NIS) in adults aged 18- 64 years with diagnosis of ischemic stroke, hemorrhagic stroke, or subarachnoid hemorrhage from 2006 to 2015 and compared hospitalization rates over two-year periods. Results: We included data from 1,750,081 hospitalizations meeting inclusion criteria. Comparing 2006-07 to 2014-15, rates of hospitalization for stroke increased significantly across all analyzed gender and racial groups except Asian/Pacific Islanders aged 18-34 and 34-45. Non-Hispanic Blacks (NHB) had the highest stroke hospitalization rates in those aged 18-44, and Asian/Pacific Islander rates were highest in ages 45-64 (Figure 1d,f). In this period, there was a 26% overall increase in risk of hospitalization for stroke in young adults with 42% (CI 1.28 - 1.57) increased risk in women aged 18-34 and 41% (1.32 -1.51) in men aged 35-44. Regionally, the South had the highest incidence of stroke hospitalization in all age groups but the highest increase in risk over the decade was seen in the Northeast. Prevalence of hypertension among hospitalized patients remained unchanged or decreased while prevalence of all other risk factors increased, mostly in obesity and lipid disorders (Figure 1h). Conclusions: Despite public awareness, stroke incidence continues to increase in young patients remaining highest among minorities and in the Southern states, but rising more in the Northeast. Personalized approaches and geographic aspects, in addition to vascular risk factor control, will all likely be needed to reduce stroke risk in these different patient populations.

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Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽

10.1161/str.48.suppl_1.wp182 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Urvish K Patel ◽

Priti Poojary ◽

Vishal Jani ◽

Mandip S Dhamoon

Keyword(s):

Risk Factors ◽

Older Adults ◽

Young Adults ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

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Abstract P672: Black White Disparity in Multiple Risk Factors is Increased in Older Young Adults

Stroke ◽

10.1161/str.52.suppl_1.p672 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Prachi Mehndiratta ◽

Kathleen Ryan ◽

Adeolu Morawo ◽

Seemant Chaturvedi ◽

Carolyn A Cronin ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Stroke Risk ◽

Reference Group ◽

Population Based ◽

Multiple Risk Factors ◽

Stroke In Young Adults ◽

Multiple Risk ◽

The Relationship ◽

Control Study

Background: Stroke in young adults constitutes 15-18% of all ischemic strokes. Vascular risk factors contribute to stroke risk in young adults particularly older young adults. Few studies have addressed Black White differences in risk, stratified by age. We evaluated the prevalence of risk factors in the younger young (less than 40 years) vs. the older young adults (40 and above). Methods: A population based case control study with 1034 cases and 1091 controls, ages 15-49 was used to investigate the relationship between risk factors (DM, HTN, Smoking and Obesity) and stroke. Groups were defined by the number of risk factors (RF) among cases and controls : no risk factors (ref group), one RF, two RF, three RF and four RF. Prevalence of risk factors was determined in the entire population and stratified by age, sex and race. Logistic regression was used to determine odds of stroke based on the number of risk factors compared to the reference group. Results: The percent of cases with three or more risk factors was compared in different subgroups: ages 15-39 vs. 40-49 was 8.4 vs. 21.6, women vs. men was 15.6 vs. 18.6 and White vs. Black was 12.3 vs. 22.7. Among cases 40 years and older, Blacks were 3 times more likely than Whites (5.9 vs. 2) to have four or more risk factors.Across all age, race and sex subgroups, the odds of having a stroke increased exponentially with an increase in the number of risk factors. Conclusion: Blacks are more likely to have multiple risk factors than Whites. This difference is accentuated in those 40 years and older. Targeting young adults with multiple risk factors for preventive interventions would address a root case of excess stroke risk especially among Blacks.

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Abstract WMP53: Traditional Vascular Risk Factors Account for Different Proportions of Ischemic Stroke Within Different Gender and Race Groups

Stroke ◽

10.1161/str.51.suppl_1.wmp53 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Elizabeth M Aradine ◽

Yan Hou ◽

Kathleen A Ryan ◽

Prachi Mehndiratta ◽

Michael S Phipps ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Black Men ◽

White Men ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Odds Ratios ◽

Stroke In Young Adults ◽

Stroke In Young

Introduction: Few studies have compared the proportion of ischemic strokes attributable to traditional vascular risk factors (population-attributable risk percent or PAR%) between genders and races. The PAR% is a function of the population prevalence and strength of association of a risk factor. Methods: A population-based case-control study of ischemic stroke in young adults ages 18-49 in the Baltimore-Washington region was used to study the prevalence, odds ratios, and PAR% of hypertension, diabetes, and smoking among blacks and whites. Logistic regression was used to calculate age-adjusted odds ratios. All analyses were stratified by gender. Results: There were 1044 cases and 1099 controls. Of the cases, 47% were black, 54% were women. Roughly a quarter to a third of all strokes in women were attributable to smoking. Due to the higher prevalence of hypertension and a higher odds ratio for hypertension in black men (OR 3.9, 95% CI 2.6-5.9) compared to white men (OR 1.8, 95% CI 1.3-2.6), there was a much higher PAR% for hypertension among black men than white men. See Table 1 for prevalence and Table 2 for PAR% stratified by gender and race. Conclusion: Traditional vascular risk factors have the potential to explain a high proportion of ischemic stroke in young adults. The high proportion of strokes in women attributable to smoking underscores the need for targeted smoking cessation interventions in this population. Diabetes and, especially, hypertension are important contributors to the excess population burden of ischemic stroke among blacks. These findings support the value of early screening and treatment for hypertension in young blacks.

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Young Adult with Headache and Blurred Vision

10.1093/med/9780190495541.003.0018 ◽

2016 ◽

Author(s):

Ji Y. Chong ◽

Michael P. Lerario

Keyword(s):

Risk Factors ◽

Young Adults ◽

Young Adult ◽

Vascular Risk ◽

High Cholesterol ◽

Blurred Vision ◽

Younger Patients ◽

Stroke In Young Adults ◽

Extensive Evaluation ◽

Stroke In Young

Traditional vascular risk factors such as hypertension, diabetes, and high cholesterol can contribute to stroke in young adults. In the absence of typical risk factors in a young patient, a more extensive evaluation is needed. Other, more unusual causes of stroke can include autoimmune, infectious, hematological, and toxic etiologies. Often, despite an exhaustive workup, the mechanism of stroke remains cryptogenic in younger patients.

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