Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults

Abstract

Background and Purpose-As stroke in young adults is assumed to have different etiologies and risk factors than in older populations, the aim of this study was to examine the contribution of established potentially modifiable cardiovascular risk factors to the burden of stroke in young adults. Methods-A German nationwide case-control study based on patients enrolled in the SIFAP1 study (Stroke In Young Fabry Patients) 2007 to 2010 and controls from the population-based GEDA study (German Health Update) 2009 to 2010 was performed. Cases were 2125 consecutive patients aged 18 to 55 years with acute first-ever stroke from 26 clinical stroke centers; controls (age-and sex-matched, n=8500, without previous stroke) were from a nationwide community sample. Adjusted population-attributable risks of 8 risk factors (hypertension, hyperlipidemia, diabetes mellitus, coronary heart disease, smoking, heavy episodic alcohol consumption, low physical activity, and obesity) and their combinations for all stroke, ischemic stroke, and primary intracerebral hemorrhage were calculated. Results-Low physical activity and hypertension were the most important risk factors, accounting for 59.7% (95% confidence interval, 56.3-63.2) and 27.1% (95% confidence interval, 23.6-30.6) of all strokes, respectively. All 8 risk factors combined explained 78.9% (95% confidence interval, 76.3-81.4) of all strokes. Population-attributable risks of all risk factors were similar for all ischemic stroke subtypes. Population-attributable risks of most risk factors were higher in older age groups and in men. Conclusions-Modifiable risk factors previously established in older populations also account for a large part of stroke in younger adults, with 4 risk factors explaining almost 80% of stroke risk. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.

Ischaemic stroke in young adults: a global perspective

“…The population attributable risks (PARs) of hypertension, diabetes mellitus, smoking and alcohol consumption were higher in men than in women. In contrast, the PARs of physical inactivity and overweight/obesity were higher in women than in men 53…”

“…The increase in vascular risk factors seems to be more pronounced in the population aged 35 years and older than in the younger population 3 6 35 57Table 1. shows the strength of the associations between stroke and common vascular risk factors based on two different case-control studies, one based on a population-based prospective control sample52 and the other with controls surveyed over telephone 53. Both studies are performed in European countries.…”

“…Both studies are performed in European countries. There remains a knowledge gap since most PAR studies for young individuals with stroke specifically lack data from South-America, Asia, Africa and Australia, leaving another knowledge gap 52–54. These continents are included in large cohort studies that have reported on the differences in risk factors from a global perspective, for example, the Global Burden Study, the INTERSTROKE study and the PURE study 58–60.…”

Risk Factors Associated with Ischemic Stroke in a Young Non-Diabetic and Non-Hypertensive Population: A Retrospective Case-Control Study

“…Traditionally, risk factors associated with over 80% of IS incidence among young adults include smoking, hypertension, obesity, diabetes, and dyslipidemia, 9 with approximately 10% and 35% of these patients being affected by diabetes and hypertension, respectively [9,10]. Even patients unaffected by these conditions still suffer from IS in some cases, however, with roughly 33% of IS cases in this age group being cryptogenous [11].…”

Scavenger Receptor Class B type 1 (SR-B1) and the modifiable risk factors of stroke

“…However, Wang et al did not observe a similar trend among women. Unsurprisingly, the risk factors for stroke in older populations also contribute to a significant proportion of stroke in younger adults [8]. The lifestyle choices of individuals across the globe subject them to an increased risk of stroke.…”