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Young adults with stroke have different risk factors and etiologies than older stroke patients and, therefore, may have different rates of stroke recurrence. However, epidemiologic data regarding recurrent ischemic events in younger patients have been limited. This study's aim was to determine recurrence rates and risk factors for ischemic events after a first ischemic stroke. Participants were 807 consecutive patients aged 15 to 49 with a first ischemic stroke treated at one hospital in Finland. The hospital provides exclusive neurological emergency care for 1.5 million people, and few patients were lost to follow-up or declined to participate. Primary endpoints were recurrent ischemic stroke, myocardial infarction, other arterial thrombotic events, and revascularization during 5 years of follow-up.
The 5-year cumulative incidence rate of recurrent stroke was 9%; the rate of the composite outcome of any ischemic event was 12%. Annual recurrence rates for stroke and the composite outcome were highest during the first year after the index stroke. Independent predictors of recurrent stroke included histories of type 1 diabetes, large-artery atherosclerosis, or transient ischemic attack. The risk for recurrent stroke was three times higher in patients with large-artery atherosclerosis by TOAST criteria than in patients with other or undetermined etiologies.
Putaala J et al. Recurrent ischemic events in young adults after first-ever ischemic stroke. Ann Neurol 2010 Nov; 68:661.
Comment
This study demonstrates that younger stroke patients are at moderate risk for recurrent stroke or other ischemic events and that stroke etiology is important in stratifying recurrence rates. The strengths of the study are its large sample size and well-defined population base, which decreases referral bias in estimating incidence rates. Although the reported 5-year cumulative incidence rate for recurrent stroke in this population is about half that reported in the general stroke population, these findings are clinically important because the lifetime cumulative risk in younger stroke patients may be substantial.