Ischemic stroke in young adults in Bogota, Colombia: a cross-sectional study

Association of modifiable risk factors with ischaemic stroke subtypes in Asian versus Caucasian populations: A systematic review and meta-analysis

BACKGROUND

Ischaemic stroke (IS) is associated with various modifiable risk factors but the association of these risk factors based on TOAST classification, which characterises IS into five subtypes: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic disease (CE), other determined aetiology (ODE) and undetermined aetiology (UDE), is unknown. We aimed to summarise the published evidence for the association of modifiable risk factors with IS subtypes based on TOAST classification, specifically focussing on the Asian versus Caucasian population.

METHOD

A comprehensive search for all the published articles was performed in electronic databases including PubMed, EMBASE, Cochrane Library, and Google Scholar from 01st January 1950 to 10th April 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Odds ratio (OR) with 95% confidence interval (CIs) along with random-effect models was used to calculate summary estimates.

RESULTS

In our meta-analysis, 32 studies with a total of 23,404 IS (14,364 in Asian vs. 9040 in Caucasian population), 7121 LAA (5219 in Asian vs. 1902 in Caucasian), 5532 SVO (3604 in Asian vs. 1928 in Caucasian), 3498 CE (1634 in Asian vs. 1864 in Caucasian), 1131 ODE (546 in Asian vs. 585 in Caucasian) and 4519 UDE (2076 in Asian vs. 2443 in Caucasian) were included. Our findings suggest a significant association between LAA and hypertension (OR = 1.07, 95% CI = 1.02-1.12), smoking (OR = 1.11, 95% CI = 1.04-1.17), dyslipidemia (OR = 1.13, 95% CI = 1.06-1.21), diabetes mellitus (OR = 1.18, 95% CI = 1.11-1.25) and atrial fibrillation (OR = 0.55, 95% CI = 0.40-0.75). Significantly strong association of hypertension, smoking, dyslipidemia, diabetes mellitus and atrial fibrillation was observed with SVO and CE stroke subtypes. Subgroup analysis based on ethnicity revealed a significant association for dyslipidemia, diabetes mellitus and atrial fibrillation in LAA for both Asians and Caucasians. Hypertension was significantly associated with SVO and ODE subtypes in both Asians and Caucasians; however, only Asian population showed significant association of hypertension in LAA and CE subtypes. The other risk factors did not show any statistical difference between the ethnic groups for the different stroke subtypes. The majority of the risk factors depicted positive association with LAA and SVO, negative with CE and neutral with ODE and UDE.

CONCLUSION

Our findings suggest strong association of smoking, dyslipidemia and diabetes mellitus with LAA and SVO subtypes in the Caucasian population. However, only diabetes mellitus showed significant association with both LAA and SVO subtypes in Asian population as well. Thus, a majority of the traditional modifiable risk factors had a positive association in LAA and SVO, while a negative protective association was observed in CE subtype, among both the Asian and the Caucasian subgroups.

Ischemic stroke in young patients in Medellín, Colombia

Background

There is scarce information about ischemic stroke in young patients in Colombia. To get insights about this phenomenon, this study describes the etiologies and risk factors of ischemic stroke in young patients in a third level complexity referral hospital in Medellin, Colombia.

Methods

A retrospective observational cross-sectional study was carried out reviewing the medical records of patients between 18 to 49 years old admitted for the first time for ischemic stroke, from January 2009 to December 2019. The sociodemographic characteristics, risk factors, and etiological classification of ischemic stroke according to the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) were described.

Results

Two hundred thirty-seven cases were found. The most frequent risk factors were arterial hypertension (31.7%), smoking (29.5%) and alcohol intake (23.2%). There was a greater number of traditional cardiovascular risk factors at older ages. The TOAST classification was large-artery atherosclerosis (6.8%), cardioembolism (17.7%), small-vessel disease (7.6%), other determined etiology (25.7%) and undetermined (42.2%). Within cardioembolism, the most common high-risk source was valve replacement, and the most common moderate-risk source was patent foramen ovale. Craniocervical arterial dissection (11.4%) and substance abuse (2.9%) were the two most frequent sources within other determined etiologies. The most common compromised vascular territory was the anterior (55.7%).

Conclusions

The high frequency of traditional risk factors in young patients highlights the need to optimize primary and secondary prevention plans. This study provides new insights about the relevance of illicit substance abuse in Colombia as a cause of stroke in young patients, unlike the previous one conducted in Bogotá. Infectious causes were other peculiarities found. It is necessary to investigate the reasons for the high proportion of undetermined causes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02895-9.

Predictors for the prognosis and recurrence of ischaemic stroke among young Chinese patients: a cohort study

OBJECTIVE

To identify predictors of young Chinese patients with ischaemic stroke outcome and recurrence of stroke.

DESIGN

Through considered the risk factors, neuroimaging findings, distribution, vascular stenosis, and the post-stroke treatment of young Chinese patients with ischemic stroke.

SETTING

The First Hospital of Jilin University.

PARTICIPANTS

We enrolled 579 patients (median age 45 years, range 15-49, men 81.0%) treated for the first occurrence of ischaemic stroke between January 2014 and December 2017.

MAIN OUTCOME MEASURES

We assessed stroke outcome based on the modified Rankin Scale (mRS) scores and recurrence of cerebrovascular events at 12 months. Multivariate logistic regression was used to identify the independent predictors of unfavourable outcomes (mRS score ≥2) and recurrence.

RESULTS

We observed stenosis in 295 patients (50.9%)-middle cerebral artery stenosis was the most common (18.1%). Of all 579 included patients, normal or mild, moderate and severe stenoses or occlusions were observed in 51.8%, 6.0% and 42.1% of patients, respectively. Unfavourable outcomes were observed in 91 patients (15.7%), including 10 patients (1.7%) who died. The rate of stroke recurrence was 7.9%. Independent predictors of unfavourable outcomes included a high National Institutes of Health Stroke Scale score (OR 1.151, 95% CI 1.094 to 1.210; p<0.001) and severe vascular stenosis or occlusion (OR 1.867, 95% CI 1.181 to 2.952; p=0.008). Predictors of recurrence included age of ≥45 years (OR 2.072, 95% CI 1.066 to 4.025; p=0.032) and atrial fibrillation (OR 15.207, 95% CI 4.273 to 54.120; p<0.001).

CONCLUSIONS

Our research shows that when developing prevention strategies for young people, measures that focus on mitigating risk factors should be considered. In addition, vascular screening of young populations is also of vital importance for stroke prevention and poor prognosis prediction.

Ischemic Stroke in Young Adults Caused by Cervical Artery Dissection-A Retrospective Study

Background  Ischemic stroke is one of the most common causes of death and disability. The most common independent cause is cervical artery dissection, which represents around 20% of all cases of ischemic stroke in young adults. Risk factors for dissection include male gender, migraine (particularly with aura), hyperhomocysteinemia, recent infection, recent history of minor cervical trauma, young age, current smoking status, increased leucocyte count, and shortened activated partial thromboplastin time, whereas hypercholesterolemia and being overweight appear protective. Patients and Methods  This retrospective study was based on data of all patients aged 18 to 49 who were hospitalized in the University Medical Centre Maribor for ischemic stroke between 2010 and 2019 inclusive. The results of the research were analyzed by IBM SPSS Statistics 28 software. For statistical significance, a cut-off value of p  < 0.05 was used. Results  The study includes 196 patients with 198 events of ischemic stroke. Dissection of cervical arteries was presented in 16 (8.2%) cases. The presence of arterial hypertension proved to have a relation with the presence of a dissection; patients with dissection are less likely to suffer from arterial hypertension. Duration of hospitalization in the group with dissection lasted significantly longer than in the group without dissection. Conclusions  Dissection of cervical or intracranial artery is an important cause of ischemic stroke, especially in young adults. Therefore, it should be considered in young adults with presentation of stroke who lack traditional and modifiable risk factors.

Health-related quality of life after thrombectomy in young-onset versus older stroke patients: a multicenter analysis

BACKGROUND

Information is lacking on self-reported health-related quality of life (HRQoL) as a complementary outcome measure in addition to the modified Rankin scale (mRS) in young patients with ischemic stroke after endovascular thrombectomy (EVT) compared with older patients.

METHODS

Data on consecutive patients with stroke who underwent thrombectomy (June 2015-2019) from a multicenter prospective registry (German Stroke Registry) were analyzed. HRQoL was measured by the European QoL-5 dimension questionnaire utility index (EQ-5D-I; higher values indicate better HRQoL) 3 months after stroke in patients aged ≤55 and >55 years. Multivariate regression analyses identified predictors of better HRQoL.

RESULTS

Of 4561 included patients, 526 (11.5%) were ≤55 years old. Young-onset patients had a better outcome assessed by mRS (mRS 0-2: 64.3% vs 31.8%, p<0.001) and EQ-5D-I (mean 0.639 vs 0.342, p<0.001). Young survivors after EVT had fewer complaints in the EQ-5D domains mobility (p<0.001), self-care (p<0.001), usual activities (p<0.001) and pain/discomfort (p=0.008), whereas no difference was observed in anxiety/depression (p=0.819). Adjusted regression analysis for 90-day mRS showed no difference in HRQoL between the two subgroups of patients. Lower age, National Institutes of Health Stroke Scale score and pre-stroke mRS, a higher Alberta Stroke Program Early CT Score, concomitant intravenous thrombolysis therapy and successful recanalization were associated with better HRQoL in both patient subgroups.

CONCLUSIONS

Young-onset stroke patients have a better HRQoL after EVT than older patients. Their higher HRQoL is mainly explained by less physical disability assessed by mRS. Depressive symptoms should be actively assessed and targeted in rehabilitation therapies of young-onset stroke patients to improve quality of life after stroke.

Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis

BACKGROUND

Stroke is still the main cause of death and disability worldwide, numerous studies of recurrence risk have been reported, while systematic estimates of stroke recurrence risk in the last 10 years are variable. This review aims to estimate the cumulative stroke recurrence risk in the last 10 years for secondary prevention management in future.

METHODS

A systematic search from January 2009 to March 2019 was conducted through PubMed, EMBASE, Web of Science, Wan-fang, and CNKI. Search terms were in English and Chinese.

RESULTS

A total of 37 studies involving 1,075,014 stroke patients were included. The pooled stroke recurrence rate was 7.7% at 3 months, 9.5% at 6 months, 10.4% at 1 year, 16.1% at 2 years, 16.7% at 3 years, 14.8% at 5 years, 12.9% at 10 years, and 39.7% at 12 years after the initial stroke. In addition, the pooled recurrence rate of 32 studies including stroke patients over 50 years only at seven time points except for subgroup of 10 years was 7.7%, 9.5%, 11.2%, 16.1%, 19.3%, 18.1%, and 39.7%, respectively. Meta-regression showed that the time points explained 23.02% of the variance among studies, while regions, age, and stroke types showed no significant contribution to heterogeneity.

CONCLUSIONS

The risk of stroke recurrence varies greatly from 3 months to over 10 years and increases significantly over time in both young and old subgroup. The heterogeneity may be explained by follow-up time, regions, age, methodology differences, and stroke types, which was needed further exploration in future.