Background and Purpose-We compared among young patients with ischemic stroke the distribution of vascular risk factors among sex, age groups, and 3 distinct geographic regions in Europe. Methods-We included patients with first-ever ischemic stroke aged 15 to 49 years from existing hospital-or population-based prospective or consecutive young stroke registries involving 15 cities in 12 countries. Geographic regions were defined as northern (Finland, Norway), central (Austria, Belgium, France, Germany, Hungary, The Netherlands, Switzerland), and southern (Greece, Italy, Turkey) Europe. Hierarchical regression models were used for comparisons. Results-In the study cohort (nϭ3944), the 3 most frequent risk factors were current smoking (48.7%), dyslipidemia (45.8%), and hypertension (35.9%). Compared with central (nϭ1868; median age, 43 years) and northern (nϭ1330; median age, 44 years) European patients, southern Europeans (nϭ746; median age, 41 years) were younger. No sex difference emerged between the regions, male:female ratio being 0.7 in those aged Ͻ34 years and reaching 1.7 in those aged 45 to 49 years. After accounting for confounders, no risk-factor differences emerged at the region level. Compared with females, males were older and they more frequently had dyslipidemia or coronary heart disease, or were smokers, irrespective of region. In both sexes, prevalence of family history of stroke, dyslipidemia, smoking, hypertension, diabetes mellitus, coronary heart disease, peripheral arterial disease, and atrial fibrillation positively correlated with age across all regions. Conclusions-Primary preventive strategies for ischemic stroke in young adults-having high rate of modifiable risk factors-should be targeted according to sex and age at continental level. (Stroke. 2012;43:2624-2630.)

The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.

Background and Purpose-According to World Health Organization statistics, Ukraine has extremely high stroke mortality. No population-based prospective studies of stroke incidence have been performed yet in this European country with Ϸ50 million inhabitants. High reported rates of stroke mortality in official statistics conflict with some locally published incidence data in Ukraine. To obtain accurate data, we evaluated stroke incidence and 30-day case fatality in a prospective population study in the West Ukrainian city of Uzhgorod with a population of 126 000 inhabitants. Methods-Case certification by neurologists and follow-up at 30 days after stroke for all patients identified by any level of the health service system were performed for a 12-month period. Results-We identified 352 stroke cases. The age-standardized incidence was 341 and 238 of 100 000 and mortality was 83 and 69 of 100 000 with the use of the European or world standard population for standardization. Mean age of stroke patients was 63.4Ϯ12.5 years. Rate of hospitalization was 66%. Hospitalized patients were Ͼ10 years younger than those treated in their homes. The 30-day case fatality rates were 15.4% among hospitalized patients and 36.8% among those treated at home. Overall 30-day case fatality was 23.3%. Conclusions-Stroke incidence and 30-day case fatality in this West Ukrainian city were similar to those of some West European countries and were much lower than what could be expected from World Health Organization statistics. The relatively low incidence rate seems accurate; because of the organization of local stroke services, it is not probable that a considerable proportion of patients with acute stroke could bypass all levels of the acute care health system. Local health statistics reported a much lower number of stroke cases and stroke deaths than found in our survey; thus, further study is needed to clarify the reason for the discrepancy between local data and the high reported stroke mortality in