Cardiovascular events after ischemic stroke in young adults

Aarnio, Karoliina; Siegerink, Bob; Pirinen, Jani; Sinisalo, Juha; Lehto, Mika; Haapaniemi, Elena; Nave, Alexander-Heinrich; Kaste, Markku; Tatlısumak, Turgut; Putaala, Jukka

doi:10.1212/wnl.0000000000002689

Cited by 24 publications

(32 citation statements)

References 26 publications

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“…23,24 While ischemic stroke historically has affected predominantly older adults, its frequency in a younger population has been increasing. 25–30 This trend is of particular concern because stroke in younger individuals may lead to disability during the most productive years of life. Risk factors for ischemic stroke in young adults include hypertension, smoking, diabetes mellitus, and obesity.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury

Kowalski

Haarbauer‐Krupa

Bell

et al. 2017

Stroke

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Background and Purpose Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. Methods A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Results Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, −16.8 to −9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3–2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1–23.4; P<0.001). Conclusions Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events.

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Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury

Kowalski

Haarbauer‐Krupa

Bell

et al. 2017

Stroke

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“…Data on recurrent vascular events and mortality were obtained from the Care Register for Health Care, from the National Institute for Health and Welfare, Finland, and from Statistics Finland, as described before [1]. Endpoints of interest were as follows: (1) all-cause mortality; (2) composite endpoint including fatal/nonfatal recurrent stroke of ischemic or hemorrhagic origin and transient ischemic attack (TIA), and (3) composite endpoint of any fatal/nonfatal vascular event including cardiac events including ACS, cardiac death and other cardiac events as well as peripheral arterial events, while excluding recurrent stroke of ischemic or hemorrhagic origin and TIA.…”

Section: Follow-up Datamentioning

confidence: 99%

“…Endpoints of interest were as follows: (1) all-cause mortality; (2) composite endpoint including fatal/nonfatal recurrent stroke of ischemic or hemorrhagic origin and transient ischemic attack (TIA), and (3) composite endpoint of any fatal/nonfatal vascular event including cardiac events including ACS, cardiac death and other cardiac events as well as peripheral arterial events, while excluding recurrent stroke of ischemic or hemorrhagic origin and TIA. Follow-up time started from the index stroke and ended on December 31st, 2011, on the date of occurrence of an endpoint of interest, or on the date of death, whichever occurred first [1].…”

Section: Follow-up Datamentioning

confidence: 99%

“…Patients with an ischemic stroke (IS) at young age are known to be at a substantial long-term risk of recurrent vascular events and death. One out of three will be affected by recurrent vascular events and the risk of mortality is 4-fold of expected, even up to 10 years after the initial event [1][2][3][4]. Furthermore, the risk of recurrence is found to be true-to-type, with high risks of a recurrent IS in young IS patients [5].…”

Section: Introductionmentioning

confidence: 99%

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Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome

et al. 2019

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Background: Knowledge on the use of secondary preventive medication in young adults is limited. Methods: We included 936 first-ever ischemic stroke 30-day survivors aged 15-49, enrolled in the Helsinki Young Stroke Registry, 1994-2007. Follow-up data until 2012 came from Finnish Care Register, Statistics Finland, and Social Insurance Institution of Finland. Usage thresholds were defined as non-users, low (prescription coverage <30%), intermediate (30-80%) and high users (>80%). Adjusted Cox regression allowed assessing the association of usage with all-cause mortality and recurrent vascular events. Results: Of our patients, 40.5% were non-users, 7.8% had low usage, 11.8% intermediate usage and 40.0% high usage. Median follow-up was 8.3 years. Compared to non-users, risk of mortality and recurrent stroke or TIA was lower for patients with low-intermediate (HR 0.40, 95% CI 0.22-0.65; HR 0.31, 95% CI 0.18-0.53) and high usage (HR 0.25, 95% CI 0.15-0.42; HR 0.30, 95% CI 0.19-0.46), after adjustment for confounders. Conclusions: Use of antihypertensives was suboptimal in one-third of patients in whom antihypertensives were initially prescribed. Users were at lower risk of mortality and recurrent stroke or TIA compared to non-users. KEY MESSAGES The use of antihypertensive medication is suboptimal in one-third of patients in whom antihypertensive medication was initially prescribed after ischemic stroke at young age. The risk of mortality and recurrent stroke or TIA is lower for users of antihypertensive medication after ischemic stroke at young age compared to non-users, after adjustment for relevant confounders including pre-existing hypertension and prior use of antihypertensive medication. Specific guidelines on antihypertensive medication use after ischemic stroke at young age are lacking. However, our results may motivate doctors and patients in gaining better usage of antihypertensive medication, since better usage was associated with more favorable outcome in this study.

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“…Nevertheless, several studies show high rates of recurrent stroke and to lesser extent other cardiovascular disease in the young suggesting active underlying pathologies, [14][15][16] also for those with undetermined causes. 17 To address the many gaps in this field and promote the understanding of risk factors, mechanisms and prognosis of early-onset cryptogenic IS, we generated the following study hypotheses:…”

Section: Introductionmentioning

confidence: 99%

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

Putaala

Martinez‐Majander

Saeed

et al. 2017

European Stroke Journal

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Background: Worldwide, about 1.3 million annual ischaemic strokes (IS) occur in adults aged <50 years. Of these early-onset strokes, up to 50% can be regarded as cryptogenic or associated with conditions with poorly documented causality like patent foramen ovale and coagulopathies. Key hypotheses/aims: (1) Investigate transient triggers and clinical/sub-clinical chronic risk factors associated with cryptogenic IS in the young; (2) use cardiac imaging methods exceeding state-of-the-art to reveal novel sources for embolism; (3) search for covert thrombosis and haemostasis abnormalities; (4) discover new disease pathways using next-generation sequencing and RNA gene expression studies; (5) determine patient prognosis by use of phenotypic and genetic data; and (6) adapt systems medicine approach to investigate complex risk-factor interactions. Design: Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is a prospective multi-centre case-control study enrolling patients aged 18-49 years hospitalised due to first-ever imaging-proven IS of undetermined etiology. Patients are examined according to a standardised protocol and followed up for 10 years. Patients are 1:1 age-and sex-matched to stroke-free controls. Key study elements include centralised reading of echocardiography, electrocardiography, and neurovascular imaging, as well as blood samples for genetic, gene-expression, thrombosis and haemostasis and biomarker analysis. We aim to have 600 patientcontrol pairs enrolled by the end of 2018. Summary: SECRETO is aiming to establish novel mechanisms and prognosis of cryptogenic IS in the young and will provide new directions for therapy development for these patients. First results are anticipated in 2019.

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Cardiovascular events after ischemic stroke in young adults

Abstract: The risk for future cardiovascular events after ischemic stroke in young adults remains high for years after the index stroke, in particular when the index stroke is caused by high-risk sources of cardioembolism or large-artery atherosclerosis.

Cited by 24 publications

References 26 publications

Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury

Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury

Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

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