scholarly journals Young Ischemic Stroke in South Asia: A review

2013 ◽  
Vol 2 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Rajeev Ojha ◽  
Dongya Huang ◽  
Hedi An ◽  
Lian Zuo ◽  
Wenxia Zhu
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
South Asia ◽  
Rural Areas ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Incidence Risk ◽  
Young Ischemic Stroke ◽  
Traditional Risk Factors ◽  
Undetermined Etiology

Stroke in young adults may have early impact on quality of life in survivors. Uncontrolled stroke risk factors, lack of treatment facilities and a dense population has made its special significance in South Asia. The main aim of this study is to evaluate incidence, risk factors, etiology and clinical characteristics of young ischemic stroke in South Asia. Incidence of young stroke is more common in South Asian countries than developed western countries and has higher prevalence in rural areas. Traditional risk factors, such as hypertension, smoking, hyperlipidemia and diabetes are associated with majority of cases. Cardioembolism and undetermined etiology contribute to a large proportion of stroke etiology. Appropriate stepwise investigations are suggested to diagnose stroke of other determined etiology. Regular intake of drugs to control risk factors, cessation of smoking, and promote physical activity is suggested to reduce the burden of young stroke. Journal of Advances in Internal Medicine 2013;02(01):27-33 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7636

Epidemiology

2018 ◽  
Author(s):  
Merel Sanne Ekker ◽  
Frank-Erik de Leeuw
Keyword(s):  
Risk Factors ◽  
Imaging Techniques ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Stroke Incidence ◽  
Young Stroke ◽  
Risk Of Death ◽  
Stroke In Young Adults ◽  
Traditional Risk Factors ◽  
Stroke In Young

Epidemiology can be used to reveal new causes of ischaemic stroke in young adults. Each year, about 2 million patients worldwide suffer a young stroke between the ages of 18 and 49 years. The overall stroke incidence is decreasing; however, an increase in the incidence of young stroke has been witnessed, possibly due to better awareness, new imaging techniques, and the increased prevalence of traditional risk factors already at a young age. Nevertheless, not all young stroke patients have cardiovascular risk factors. The proportion of patients with arterial dissection, cardioembolic stroke, and cryptogenic stroke is higher in young patients than in older patients. This chapter uses sex differences in both incidence and prognosis to provide leads for new risk factors in young men and women. Lastly, prognosis after young stroke is poor. The risk of death is higher than expected from the general population and remains high even years after stroke. Young stroke strikes suddenly, with attendant life-long consequences.

Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

2021 ◽  
Author(s):  
Lamia M’barek ◽  
Salma Sakka ◽  
Fatma Megdiche ◽  
Nouha Farhat ◽  
Khadija Maalla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Genetic Markers ◽  
Traditional Risk Factors

scholarly journals Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Xu ◽  
Xiaoyu Zhang ◽  
Huan Chen ◽  
Zhangning Zhao ◽  
Meijia Zhu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Factor Score ◽  
Unfavorable Outcome ◽  
Stroke Patients ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Risk Factor Score ◽  
Stroke In Young

Abstract Background Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations. Methods Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome. Results Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome. Conclusions Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kavelin Rumalla ◽  
Adithi Y Reddy ◽  
Vijay Letchuman ◽  
Paul A Berger ◽  
Manoj K Mittal
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bowel Obstruction ◽  
Kidney Injury ◽  
Hospital Death ◽  
Stroke Incidence ◽  
Black Race ◽  
Electrolyte Disorder ◽  
Incidence Risk

Introduction: The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported. Methods: We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. Results: We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p<0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p<0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p<0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p<0.0001). Conclusion: Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.

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

Stroke ◽  
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.

Gender differences in cardiovascular risk assessment in elderly adults in Ecuador: evidence from a national survey

2018 ◽  
Vol 67 (4) ◽  
pp. 736-742
Author(s):  
Ivan Sisa
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cardiovascular Risk ◽  
Rural Areas ◽  
Risk Model ◽  
Smoking Status ◽  
Population Based ◽  
Cvd Risk ◽  
Serum Triglycerides ◽  
Traditional Risk Factors

The present study aimed to predict the risk of developing cardiovascular disease (CVD) over a 5-year period and how it might vary by sex in an ethnically diverse population of older adults. We used a novel CVD risk model built and validated in older adults named the Systematic Coronary Risk Evaluation in Older Persons (SCORE OP). A population-based study analyzed a total of 1307 older adults. Analyses were done by various risk categories and sex. Of the study population, 54% were female with a mean age of 75±7.1 years. According to the SCORE OP model, individuals were classified as having low (9.8%), moderate (48.1%), and high or very high risk (42.1%) of CVD-related mortality. Individuals at higher risk of CVD were more likely to be male compared with females, 53.9% vs 31.8%, respectively (p<0.01). Males were more likely to be younger, living in rural areas, had higher levels of schooling, and with the exception of smoking status and serum triglycerides, had lower values of traditional risk factors than females. In addition, males were less likely to require blood pressure-lowering therapy and statin drugs than females. This gender inequality could be driven by sociocultural determinants and a risk factor paradox in which lower levels of the cardiovascular risk factors are associated with an increase rather than a reduction in mortality. These data can be used to tailor primary prevention strategies such as lifestyle counseling and therapeutic measures in order to improve male elderly health, especially in low-resource settings.

scholarly journals Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031144
Author(s):  
Merel Ekker ◽  
Mina Jacob ◽  
Myrna van Dongen ◽  
Karoliina Aarnio ◽  
Arunkar Annamalai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Secondary Prevention ◽  
Stroke Risk ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Stroke In Young

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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