Risk factors for ischemic stroke and transient ischemic attack in patients under age 50

Abstract

To analyze risk factors for ischemic stroke and transient ischemic attack (TIA) in young adults under the age of 50. To make recommendations for additional research and practical consequences. From 97 patients with ischemic stroke or TIA under the age of 50, classical cardiovascular risk factors, coagulation disorders, history of migraine, use of oral contraceptives, cardiac abnormalities on ECG and echocardiography, and the results of duplex ultrasound were retrospectively analyzed. Literature was reviewed and compared to the results. 56.4% of the patients had hypertension, 12.1% increased total cholesterol, 20% hypertriglyceridemia, 31.5% an increased LDL-level, 32.6% a decreased HDL-level and 7.2% a disturbed glucose tolerance. Thrombophilia investigation was abnormal in 21 patients and auto-immune serology was abnormal in 15 patients. Ten of these patients were already known with a systemic disease associated with an increased risk for ischemic stroke (i.e. systemic lupus erythematosus). The ECG was abnormal in 16.7% of the cases, the echocardiography in 12.1% and duplex ultrasound of the carotid arteries was in 31.8% of the cases abnormal. Conventional cardiovascular risk factors are not only important in patients over the age of 50 with ischemic stroke or TIA, but also in this younger population under the age of 50. Thrombophilia investigation and/ or autoimmune serology should be restricted to patients without conventional cardiovascular risk factors and a history or other clinical symptoms associated with hypercoagulability and/ or autoimmune diseases.

The Role of Classic Risk Factors and Prothrombotic Factor Gene Mutations in Ischemic Stroke Risk Development in Young and Middle-Aged Individuals

“…A very similar profile of classic vascular risk factors in young ischemic stroke patients has also been reported elsewhere, however, differing in the order of frequency [3][4][5][6][7][15][16][17][18][19]. These results show that conventional vascular risk factors are significant risk factors for ischemic stroke not only in the >55 age group, but also in younger population.…”

Ischemic stroke in young adults: classification and risk factors

“…Hypertension and hyperlipidemia were also quite common in these studies (22-56 and 17-59%, respectively), in approximately the same levels as in our study (31.4 and 27.6%, respectively). Diabetes was found in 6.7% of our patients, i.e., with a similar frequency as in other comparable studies (5-17%) [5,9,15,18,19]. Overall, 58.7% patients had one or more atherosclerotic risk factors (not counting smoking), which is close to what [11].…”

“…In our population, the most common risk factor was smoking (55.2%). Other studies on young stroke patients have also found a high percentage of smokers; however, not as high as in our study (37-44%), with the exception of the study performed by Spengos et al, who found almost 60% of smokers in their population of Greek stroke patients [5,9,15,18,19]. Hypertension and hyperlipidemia were also quite common in these studies (22-56 and 17-59%, respectively), in approximately the same levels as in our study (31.4 and 27.6%, respectively).…”

Phenotypic ASCO Characterisation of Young Patients with Ischemic Stroke in the Prospective Multicentre Observational sifap1 Study

“…Some studies reported a higher prevalence of uncommon aetiologies such as cervical arterial dissection (CAD) or stroke related to pregnancy or migraine [2][3][4][5] , whereas more recent studies suggested surprisingly similar risk factor profiles in young and old stroke patients [6][7][8] . One study with patients under 50 years showed a high percentage (47.9%) of previous cardio-or cerebrovascular events, which is in line with the latter findings [7] .…”