Background and Purpose-To analyze trends in occurrence, risk factors, etiology, and neuroimaging features of ischemic stroke in young adults in a large cohort. Comparisons were done between groups stratified by gender and age. Results-Estimated annual occurrence was 10.8/100 000 (range 8.4 to 13.0), increasing exponentially with aging. Of our 628 male and 380 female (ratio 1.7:1) patients, females were preponderant among those Ͻ30, whereas male dominance rapidly increased around age of 44. The most frequent risk factors were dyslipidemia (60%), smoking (44%), and hypertension (39%). Males and patients Ͼ44 clearly had more risk factors. Cardioembolism (20%) and cervicocerebral artery dissection (15%) were the most frequent etiologic subgroups. Proportions of large-artery atherosclerosis (8%) and small-vessel disease (14%) began to enlarge at age 35, whereas frequency of undetermined etiology (33%) decreased along aging. Posterior circulation infarcts were more common among patients Ͻ45 years of age. Left hemisphere infarcts were more frequent in general. There were 235 (23%) patients with multiple and 126 (13%) with silent infarcts, and 55 (5%) patients had leukoaraiosis. Conclusions-The frequency of ischemic stroke increases sharply at age 40. Etiology and risk factors start resembling those seen in the elderly in early midlife but causes defined in younger patients still are frequent in those aged 45 to 49. Subclinical infarcts were surprisingly common in the young.

In the largest published series of patients with CEAD, we observed significant differences between VAD and ICAD in terms of risk factors, baseline features, and functional outcome.

Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year)1. Minor cervical traumas, infection, migraine and hypertension are putative risk factors1–3, and inverse associations with obesity and hypercholesterolemia are described3,4. No confirmed genetic susceptibility factors have been identified using candidate gene approaches5. We performed genome-wide association studies (GWAS) in 1,393 CeAD cases and 14,416 controls. The rs9349379[G] allele (PHACTR1) was associated with lower CeAD risk (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.69–0.82; P = 4.46 × 10−10), with confirmation in independent follow-up samples (659 CeAD cases and 2,648 controls; P = 3.91 × 10−3; combined P = 1.00 × 10−11). The rs9349379[G] allele was previously shown to be associated with lower risk of migraine and increased risk of myocardial infarction6–9. Deciphering the mechanisms underlying this pleiotropy might provide important information on the biological underpinnings of these disabling conditions.

Despite their young age, these individuals were at marked risk of recurrent arterial events, predicted by mostly modifiable baseline factors.

on behalf of the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) GroupBackground-Little is known about the risk factors for cervical artery dissection (CEAD), a major cause of ischemic stroke (IS) in young adults. Hypertension, diabetes mellitus, smoking, hypercholesterolemia, and obesity are important risk factors for IS. However, their specific role in CEAD is poorly investigated. Our aim was to compare the prevalence of vascular risk factors in CEAD patients versus referents and patients who suffered an IS of a cause other than CEAD (non-CEAD IS) in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study. Methods and Results-The study sample comprised 690 CEAD patients (mean age, 44.2Ϯ9.9 years; 43.9% women), 556 patients with a non-CEAD IS (44.7Ϯ10.5 years; 39.9% women), and 1170 referents (45.9Ϯ8.1 years; 44.1% women). We compared the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, smoking, and obesity (body mass index Ն30 kg/m 2 ) or overweightness (body mass index Ն25 kg/m 2 and Ͻ30 kg/m 2 ) between the 3 groups using a multinomial logistic regression adjusted for country of inclusion, age, and gender. Compared with referents, CEAD patients had a lower prevalence of hypercholesterolemia (odds ratio 0.55; 95% confidence interval, 0.42 to 0.71; PϽ0.0001), obesity (odds ratio 0.37; 95% confidence interval, 0.26 to 0.52; PϽ0.0001), and overweightness (odds ratio 0.70; 95% confidence interval, 0.57 to 0.88; Pϭ0.002) but were more frequently hypertensive (odds ratio 1.67; 95% confidence interval, 1.32 to 2.1; PϽ0.0001). All vascular risk factors were less frequent in CEAD patients compared with young patients with a non-CEAD IS. The latter were more frequently hypertensive, diabetic, and current smokers compared with referents. Conclusion-These results, from the largest series to date, suggest that hypertension, although less prevalent than in patients with a non-CEAD IS, could be a risk factor of CEAD, whereas hypercholesterolemia, obesity, and overweightness are inversely associated with CEAD. 4 -7 However, their specific impact on the occurrence of CEAD is poorly understood. Indeed, although the relationship of CEAD with vascular risk factors has been investigated in the past, studies were performed in small cohorts, 8 -19 and only 2 studies were specifically designed to assess this relationship. 16,19 A few studies reported a lower prevalence of vascular risk factors in CEAD patients compared with young patients with an IS of a cause other than CEAD (non-CEAD IS), 8 -10 whereas others did not observe any significant association. [11][12][13][14] Studies including referents are scarce [15][16][17]19 and yielded contradictory results: 1 study found no association 17 ; another observed a lower body mass index (BMI) 19 ; and 2 other studies found an increased prevalence of hypertension in CEAD patients compared with referents. 15,16 Clinical Perspective on p 1544The aim of the present analysis was to compare the prevalence of vascular ri...