A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke

Abstract

Purpose of Review Recent data identifies increases in young ischemic and hemorrhagic strokes. We provide a contemporary overview of current literature on stroke among young patients or premature stroke along with directions for future investigation. Recent Findings Strokes in the young are highly heterogenous and often cryptogenic. Sex distribution and risk factors shift from women among the youngest age groups (< 35) to men over the age of 45, with a coinciding rise in traditional vascular risk factors. Incidence is higher in minority and socioeconomically disadvantaged populations, and the impact of stroke among these communities may be exaggerated by disparities in symptom recognition and access to care. Special diagnostic work-up may be needed, and a lower threshold for diagnosis is warranted as potential misdiagnosis is a concern and may preclude necessary triage and management. Summary Although “premature strokes” form a relatively small proportion of total incidence, they vary greatly across subgroups and present an outsized impact on quality of life and productivity.

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“…The recent Global Burden of Disease Study 2019 suggests that in 2019, stroke is the second leading cause of death and the third leading cause of death and disability [3]. The burden of disease for stroke has risen signi cantly over the past 30 years, especially among younger populations [4]. The World Stroke Organization predicts that stroke mortality will continue to increase by 50% over the next 30 years, as will its disability-adjusted life years [5].…”

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“…Those who did, may have lacked the power to reveal a significant seasonal trend in the young age categories, due to smaller numbers, 8 or used broad age categories (⩾70 vs <70), which may not adequately represent young adults. 7 The etiologies of ischemic cerebrovascular events, as well as the prevalence of cardiovascular risk factors, are known to differ with age 18,19 and vary across different seasons. 20,21 This may lead to seasonal variation in the occurrence of events according to age, and thus hold important epidemiological and practical implications to better understand and reduce the burden of stroke.…”

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“…In addition, although stroke incidence is signi cantly higher in older populations, cumulative research suggests that stroke incidence is increasing in early onset/young adults (generally de ned as those younger than 50 years of age) [6]. Premature stroke carries a disproportionate burden of disease compared to older populations and is associated with higher DALYs and long-term stroke complications and recurrent events [7]. Despite signi cant advances in stroke treatment in recent decades, prevention of stroke onset, progression, and recurrence remains central to stroke management [8].…”