Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study

Atrial fibrillation in young stroke patients: Associated factors and outcomes in a nationwide analysis

BACKGROUND AND PURPOSE

Knowledge about the prevalence of atrial fibrillation (AF) in young stroke patients, as well as its associated factors and outcomes, is scarce. Our objective was to analyse it.

METHODS

A retrospective analysis of the Spain Nationwide Minimum Basic Data Set (MBDS) (2016-2020), including ischaemic stroke (IS) patients aged 18 and 50 years, was conducted. Multivariate analyses were conducted to identify factors related to AF diagnosis.

RESULTS

Amongst 11,615 young IS patients, 426 (3.7%) had AF. Patients with AF were older (median age 45, interquartile range 42-48 vs. 44, interquartile range 40-47 years, p < 0.001) and displayed more incapacitating symptoms, higher in-hospital complications and were less often discharged home (p < 0.001). Multivariate analyses showed that older age (odds ratio [OR] 1.053, 95% confidence interval [CI] 1.032-1.074), obstructive sleep apnoea (OR 1.508, 95% CI 1.018-2.233), hyperthyroidism (OR 3.741, 95% CI 1.798-7.783), valvular heart disease (OR 6.094, 95% CI 4.261-8.716), congenital (OR 2.386, 95% CI 1.146-4.969) and non-congenital (OR 4.446, 95% CI 3.149-6.278) cardiopathies and heart failure (OR 3.098, 95% CI 1.905-5.037) were independently associated with higher probability of AF, whereas female gender (OR 0.647, 95% CI 0.516-0.812), diabetes mellitus (0.487, 95% CI 0.339-0.699), smoking (OR 0.617, 95% CI 0.501-0.759), patent foramen ovale (OR 0.210, 95% CI 0.111-0.396) and arterial dissection (OR 0.294, 95% CI 0.130-0.668) were associated with a lower probability.

CONCLUSIONS

In young IS patients, AF is associated with more in-hospital complications and disabling strokes. These findings emphasize the need to recognize AF in this demographic group, especially in patients with risk factors like hyperthyroidism and cardiomyopathies. Clinicians should assess these risk factors to ensure timely diagnosis and management of AF.

Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study

BACKGROUND

Despite women having fewer traditional risk factors (eg, hypertension, diabetes), strokes are more common in women than men aged ≤45 years. This study examined the contributions of traditional and nontraditional risk factors (eg, migraine, thrombophilia) in the development of strokes among young adults.

METHODS

This retrospective case-control study used Colorado's All Payer Claims Database (2012-2019). We identified index stroke events in young adults (aged 18-55 years), matched 1:3 to stroke-free controls, by (1) sex, (2) age±2 years, (3) insurance type, and (4) prestroke period. All traditional and nontraditional risk factors were identified from enrollment until a stroke or proxy-stroke date (defined as the prestroke period). Conditional logistic regression models stratified by sex and age group first assessed the association of stroke with counts of risk factors by type and then computed their individual and aggregated population attributable risks.

RESULTS

We included 2618 cases (52% women; 73.3% ischemic strokes) and 7827 controls. Each additional traditional and nontraditional risk factors were associated with an increased risk of stroke in all sex and age groups. In adults aged 18 to 34 years, more strokes were associated with nontraditional (population attributable risk: 31.4% men and 42.7% women) than traditional risk factors (25.3% men and 33.3% women). The contribution of nontraditional risk factors declined with age (19.4% men and 27.9% women aged 45-55 years). The contribution of traditional risk factors peaked among patients aged 35 to 44 years (32.8% men and 39.7% women). Hypertension was the most important traditional risk factor and increased in contribution with age (population attributable risk: 27.8% men and 26.7% women aged 45 to 55 years). Migraine was the most important nontraditional risk factor and decreased in contribution with age (population attributable risk: 20.1% men and 34.5% women aged 18-35 years).

CONCLUSIONS

Nontraditional risk factors were as important as traditional risk factors in the development of strokes for both young men and women and have a stronger association with the development of strokes in adults younger than 35 years of age.

Stroke in Young Adults in Spain: Epidemiology and Risk Factors by Age

INTRODUCTION

Recent research has highlighted an increased incidence of ischemic stroke (IS) in young adults, along with a higher percentage of vascular risk factors at younger ages. This study aimed to estimate the in-hospital incidence of IS and associated comorbidities by sex and age group in Spain.

METHODS

A retrospective analysis of the Spain Nationwide Inpatient Sample database from 2016 to 2019 was conducted, which included adult patients with IS. In-hospital incidence and mortality rates were estimated, and a descriptive analysis of the main comorbidities was performed, stratified by sex and age groups.

RESULTS

A total of 186,487 patients were included, with a median age of 77 (IQR 66-85) years and 53.3% were male. Of these, 9162 (5%) were aged between 18 and 50 years. The estimated incidence of IS in adults younger than 50 years ranged from 11.9 to 13.5 per 100,000 inhabitants during the study period, with a higher incidence in men. The overall in-hospital mortality was 12.6%. Young adults with IS had a higher prevalence of most vascular risk factors compared to the general Spanish population, with a specific distribution according to sex and age.

CONCLUSIONS

This study provides estimates of the incidence of IS and the prevalence of vascular risk factors and comorbidities associated with IS in Spain, stratified by sex and age, using a national registry of hospital admissions. These findings should be considered in terms of both primary and secondary prevention strategies.