Short-term and long-term risk of recurrent ischemic strokes in young adults by cause

1. In a cohort of young patients with a first-ever stroke, the cumulative 6-month and 5-year risk of any recurrent vascular event was 6.7% and 12.2%, respectively.

2. Elevated short-term risk of recurrence was significantly higher for patients with cervical artery dissection (CeAD), atherothrombotic stroke, other rare causes of stroke, and hypertension.

3. Elevated long-term risk of recurrence was significantly higher for patients with cardioembolic stroke, a history of diabetes, and a history of alcohol abuse.

Evidence Rating Level:  2 (Good)

Over the last 2 decades, the incidence of ischemic stroke in young adults has significantly risen. There is a paucity of literature on the risk of recurrent vascular events by stroke cause in young adults, and previous research suffered from small sample sizes, outdated prevention methods, and the inclusion of patients without neuroimaging proof. This study aims to assess the short- and long-term risk of recurrent vascular events by cause and to identify high-risk subgroups of patients. Data from the prospective, multicenter Observational Dutch Young Symptomatic Stroke Study was utilized to identify and evaluate 1216 patients with an index ischemic stroke confirmed on neuroimaging (median [IQR] age, 44.2 [38.4-47.7] years; 48.0% female; median [IQR] follow-up, 4.3 [2.6-6.0] years). 137 patients (11.3%) had recurrent vascular events with 82 patients (6.7%) having their first recurrence within 6 months of their index stroke. The cumulative 6-month and 5-year incidence for any vascular event was 6.7% (95% CI, 5.3%-8.1%) and 12.2% (95% CI, 10.2%-14.2%), respectively. The incidence rate per 100 person-years for any vascular event (14.1; 95% CI, 12.6-15.6) peaked in the first 6 months post-stroke, then decreased to 1.8 (95% CI, 1.2-2.3) between 6 months and 1 year. Patients with CeAD had the highest short-term cumulative risk of any recurrent event at 13.2%, while patients with atherothrombotic stroke had the highest long-term risk of recurrence at 22.7%. In multivariate analysis, the risk of any short-term vascular event was significantly higher for patients with CeAD (HR, 4.6; P<.001, atherothrombotic stroke  (HR, 3.5; P = .02), and other rare causes of stroke (HR, 3.2; P = .008) compared with cryptogenic stroke. Hypertension was also associated with an elevated short-term risk of recurrence (HR, 2.6; P=.006). The long-term risk was significantly higher for patients with cardioembolic stroke (HR, 2.6; P=.04) compared with cryptogenic stroke and patients with a history of diabetes and alcohol abuse. Overall, a significant number of young patients experience a recurrent vascular event within 5 years,  with the cause of stroke influencing recurrence rates.

Click to read the study in JAMA Network Open

Image: PD

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