Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

Ekker, Merel S.; Jacob, Mina A.; Dongen, Myrna Van; Aarnio, Karoliina; Annamalai, Arunkar; Araúz, Antonio; Arnold, Marcel; Barboza, Miguel A; Bolognese, Manuel; Brouns, Raf; Chuluun, Batnairamdal; Chuluunbaatar, Enkhzaya; Dagvajantsan, Byambasuren; Debette, Stéphanie; Don, Adi; Enzinger, Christian; Eki̇zoğlu, Esme; Fandler‐Höfler, Simon; Fazekas, Franz; Fromm, Anette; Gattringer, Thomas; Gulli, Giosuè; Hoffmann, Michael; Hora, Thiago Falcão; Jern, Christina; Jood, Katarina; Kamouchi, Masahiro; Kim, Young Seo; Kitazono, Takanari; Kittner, Steven J.; Kleinig, Timothy; Klijn, Karin; Kõrv, Janika; Lee, Tsong‐Hai; Leys, Didier; Maaijwee, Noortje A.M.; Martinez‐Majander, Nicolas; Marto, João Pedro; Mehndiratta, Man Mohan; Mifsud, Victoria; Montanaro, Vinícius Viana Abreu; Owolabi, Mayowa; Patel, Vinod; Phillips, Matthew; Piechowski-Iozwiak, Bartlomiej; Pikula, Aleksandra; Ruiz-Sandoval, José Luís; Sarnowski, Bettina von; Schreuder, Floris H.B.M.; Swartz, Richard H.; Tan, Kay Sin; Tanné, David; Tatlısumak, Turgut; Thijs, Vincent; Tuladhar, Anil M.; Viana-Baptista, Miguel; Vibo, Riina; Wu, Teddy Y; Yeşilot, Nilüfer; Waje‐Andreassen, Ulrike; Pezzini, Alessandro; Putaala, Jukka; Leeuw, Frank‐Erik de

doi:10.1136/bmjopen-2019-031144

Cited by 8 publications

(18 citation statements)

References 25 publications

(26 reference statements)

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“…Detailed definitions of collected risk factors are described in the study protocol 13 and summarized in eTable 2 (doi.org/10.5061/dryad.1rn8pk0t4). Risk factors included vascular risk factors, as stated by the 2014 guidelines of the American Stroke Association, 17 including hypertension, diabetes, dyslipidemia, ever smoking, atrial fibrillation (AF), patent foramen ovale (PFO), and obesity.…”

Section: Methodsmentioning

confidence: 99%

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Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults—A Worldwide Meta-analysis

Jacob

Ekker²,

Allach³

et al. 2022

Neurology

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Background and Objectives:There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional healthcare services. To study the global distribution of risk factors, causes and 3-month mortality of young ischemic stroke patients, by performing a patient data meta-analysis form different cohorts worldwide.Methods:We did a pooled analysis of individual patient data from cohort studies which included consecutive ischemic stroke patients aged 18-50 years. We studied differences in prevalence of risk factors and causes between different ethnic and racial groups, geographic regions and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.Results:We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Blacks (hypertension, 52.1%; diabetes, 20.7%) and Asians (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often cause of stroke in high-income countries (HICs; both p<0.001), whereas ‘’other determined stroke’’ and ‘’undetermined stroke’’ were higher in low and middle-income countries (LMICs; both p<0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (OR 2.49; 95% CI 1.42-4.36).Discussion:The ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial, and regional differences in incidence of ischemic stroke. Our results also visualize the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve healthcare facilities in LMICs.

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Section: Methodsmentioning

confidence: 99%

“…Detailed definitions of collected risk factors are described in the study protocol 13 and summarized in eTable 2 (doi.org/10. 5061/dryad.1rn8pk0t4).…”

Section: Risk Factors Causes and Outcomementioning

confidence: 99%

Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults—A Worldwide Meta-analysis

Jacob

Ekker²,

Allach³

et al. 2022

Neurology

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“…37 Increased CCA-IMT probably reflects vascular ageing, compensating for the loss in vessel wall elasticity. 38 A recent meta-analysis confirmed that the annual increase in CCA-IMT was linear with age in 32 studies involving 10,124 healthy individuals, and that in populations with cardiovascular risk factors or overt cardiovascular disease (115 studies, 65,774 individuals), the annual increase in CCA-IMT was comparable to that of asymptomatic individuals. 39 Thus, alternative approaches were examined to improve our understanding of preclinical atherosclerosis.…”

Section: Structural Vessel Wall Parametersmentioning

confidence: 92%

“…IPH has been focus of attention in recent years, as detection of IPH on carotid plaque MRI is strongly associated with future stroke in several meta-analyses. [38][39][40] IPH may be caused by erythrocyte extravasation from leaky newly formed vessels within the plaque. 41,42 Alternatively, several reports have shown a relation between small fissures in the fibrous cap and IPH, suggestive that IPH can also originate from hemorrhage from the lumen.…”

Section: Atherosclerosis: the Vulnerable Plaquementioning

confidence: 99%

“…US measurement of dynamic plaque behavior has been briefly mentioned in the previous paragraph. confidence interval (CI): 1.5-6.0) 39 , TRFC (HR 5.9; 95%-CI 2.7-13.3) 39 and IPH (HR between 4.6 (95%-CI 2.9-7.2) and 12.2 (95%-CI 5.5-27.1)) [38][39][40] . A recent individual patient data metaanalysis has confirmed the value of detecting IPH.…”

Section: Ultrasound Imagingmentioning

confidence: 99%

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Non-Invasive Imaging of the Carotid Artery

Schreuder¹

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Diverging Temporal Trends in Stroke Incidence in Younger vs Older People

Scott

Rothwell

2022

JAMA Neurol

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ImportanceOverall stroke incidence is falling in high-income countries, but data on time trends in incidence of young stroke (ie, stroke in individuals younger than 55 years) are conflicting. An age-specific divergence in incidence, with less favorable trends at younger vs older ages, might be a more consistent underlying finding across studies.ObjectiveTo compare temporal trends in incidence of stroke at younger vs older ages in high-income countries.Data SourcesPubMed and EMBASE were searched from inception to February 2022. One additional population-based study (Oxford Vascular Study) was also included.Study SelectionStudies reporting age-specific stroke incidence in high-income countries at more than 1 time point.Data Extraction and SynthesisFor all retrieved studies, 2 authors independently reviewed the full text against the inclusion criteria to establish their eligibility. Meta-analysis was performed with the inverse variance–weighted random-effects model. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed.Main Outcomes and MeasuresThe main outcome was age-specific divergence (&lt;55 vs ≥55 years) in temporal trends in stroke incidence (relative temporal rate ratio [RTTR]) in studies extending to at least 2000. RTTRs were calculated for each study and pooled by random-effects meta-analysis, with stratification by administrative vs prospective population-based methodology, sex, stroke subtype (ischemic vs intracerebral hemorrhage vs subarachnoid hemorrhage) and geographical region.ResultsAmong 50 studies in 20 countries, 26 (13 prospective population-based and 13 administrative studies) reported data allowing calculation of the RTTR for stroke incidence at younger vs older ages across 2 or more periods, the latest extending beyond 2000. Reported trends in absolute incidence of young individuals with stroke were heterogeneous, but all studies showed a less favorable trend in incidence at younger vs older ages (pooled RTTR = 1.57 [95% CI, 1.42-1.74]). The overall RTTR was consistent by stroke subtype (ischemic, 1.62 [95% CI, 1.44-1.83]; intracerebral hemorrhage, 1.32 [95% CI, 0.91-1.92]; subarachnoid hemorrhage, 1.54 [95% CI, 1.00-2.35]); and by sex (men, 1.46 [95% CI, 1.34-1.60]; women, 1.41 [95% CI, 1.28-1.55]) but was greater in studies reporting trends solely after 2000 (1.51 [95% CI, 1.30-1.70]) vs solely before (1.18 [95% CI, 1.12-1.24]) and was highest in population-based studies in which the most recent reported period of ascertainment started after 2010 (1.87 [95% CI, 1.55-2.27]).Conclusions and RelevanceTemporal trends in stroke incidence are diverging by age in high-income countries, with less favorable trends at younger vs older ages, highlighting the urgent need to better understand etiology and prevention of stroke at younger ages.

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Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

Cited by 8 publications

References 25 publications

Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults—A Worldwide Meta-analysis

Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults—A Worldwide Meta-analysis

Non-Invasive Imaging of the Carotid Artery

Diverging Temporal Trends in Stroke Incidence in Younger vs Older People

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