Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults

Sarecka-Hujar, Beata; Kopyta, Ilona

doi:10.3390/brainsci10010024

Cited by 19 publications

(20 citation statements)

References 98 publications

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“…Based on recent studies, hypertension was considered a risk factor of recurrent stroke in adults. 4,7 Indeed, Pezzini et al 6 reported that blood pressure increases the risk of recurrent stroke by 2-fold (HR: 2.36). Schneider et al 12 demonstrated that 69% of recurrent stroke patients in Estonia have hypertension.…”

Section: Discussionmentioning

confidence: 99%

Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Mbarek

Sakka

Megdiche

et al. 2021

Journal of Thrombosis and Haemostasis

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Background The involvement of traditional risk factors and combined genetic markers of recurrent arterial ischemic stroke (AIS) in adults remains unclear. Objective This study aims to determine significant clinical and genetic factors of AIS recurrence, and to investigate the combined effect of genotypes on the occurrence of a second cerebral ischemic attack. Methods We investigated a cohort study of AIS patients (18–50 years old) followed in the neurology department over 5 years. Traditional and genetic risk factors were carried through a multivariable logistic regression model. We used a Cox proportional hazard model for identifying predictors of recurrence. Results Two hundred and seventy patients were enrolled in our study. The risk of AIS recurrence was 36.2% within 5 years. The potential risk of recurrence of AIS increased with traditional and genetic risk factors such as hypertension, diabetes mellitus, heart failure, and family history of cerebrovascular diseases. This risk increased with increasing number of genetic factors. The hazard ratio (HR) was 0.66 (95% confidence interval [CI] 0.97–2.67) for the subject with one genetic factor, 1.61 (95% CI 0.97–2.25) for combined methylenetetrahydrofolate reductase (MTHFR) polymorphisms, and 2.57 (95% CI 1.32–4.99) for combined factor V Leiden (FVL) and MTHFR polymorphisms (677 or 1298). The HR for the three polymorphisms combined was 6.04 (95% CI 2.40–15.16). Conclusions Our findings suggest that cumulative effect of both traditional and common genetic risk factors was associated with recurrence of ischemic stroke. We demonstrated for the first time that a combined genotype FVL/MTHFR profile increase the risk of a second cerebral ischemic attack.

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Section: Discussionmentioning

confidence: 99%

Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Mbarek

Sakka

Megdiche

et al. 2021

Journal of Thrombosis and Haemostasis

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“…In a group of adult patients with IS, 10–15% of all strokes were experienced by so-called “young stroke” adults. 11 Nevertheless, heterogeneity in “young stroke” definition lead to a wide range of stroke incidence in this patient population. 11 Emerging data has elevated public health concerns about the increasing prevalence of vascular risk factors in young adults, and their potential role in increasing the risk of IS, and stroke recurrence.…”

Section: Introductionmentioning

confidence: 99%

“… 11 Nevertheless, heterogeneity in “young stroke” definition lead to a wide range of stroke incidence in this patient population. 11 Emerging data has elevated public health concerns about the increasing prevalence of vascular risk factors in young adults, and their potential role in increasing the risk of IS, and stroke recurrence. 12 Although the global risk of mortality is low, stroke in young adults has severe implications.…”

Section: Introductionmentioning

confidence: 99%

Population-based Study Comparing Predictors of Ischemic Stroke Recurrence After Index Ischemic Stroke in Non-elderly Adults with or without Diabetes

Elhefnawy¹,

Ghadzi²,

Tangiisuran³

et al. 2021

IJGM

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Background and Purpose Factors associated with ischemic stroke (IS) recurrence and the contribution of pharmacological treatment as secondary preventions among nondiabetics especially in the non-elderly population are unclear and not widely investigated. This was a population-based study that aimed to identify recurrent IS predictors and to determine the possible impact of secondary preventive medications on the IS recurrence in non-elderly adults with or without diabetes. Methods Data of 3386 patients <60 years old who had a history of index IS were extracted from the Malaysian National Neurology Registry (NNEUR) from 2009 to 2016. Recurrent IS was defined as any IS event recorded after the index IS in the NNEUR database. Multivariate logistic regression analysis was performed by using SPSS version 22. Results Ischemic heart disease (IHD) was the significant predictor of IS recurrence in non-elderly adults both with or without diabetes (adjusted odds ratio (AOR) of 3.210; 95%CI: 1.909–5.398 and 2.989; 95%CI: 1.515–5.894) respectively). Receiving antiplatelet as secondary stroke prevention (AOR: 0.194; 95%CI: 0.046–0.817) and continuation of antidiabetic medication after the index IS event (AOR: 0.510; 95%CI: 0.298–0.872) reduced the odds of IS recurrence only in non-elderly diabetic adults. Among non-elderly adults without diabetes, hyperlipidemia and every increased in 1 mmHg of systolic blood pressure significantly increased the odds of IS recurrence following the indexing event (AOR: 1.796; 95%CI: 1.058–3.051 and 1.009; 95%CI: 1.002–1.016 respectively). Conclusion IHD was found as the main predictor of IS recurrence regardless of diabetes status in non-elderly adults after the index IS event. Receiving antidiabetic and antiplatelet medications upon discharge after index IS were significant predictors of recurrent IS in non-elderly diabetic adults. A proper randomized clinical trial may be required to determine the impact of secondary preventive medication on IS recurrence, especially in non-elderly adults.

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“…In pediatric populations, the risk factors associated with AIS are cardiac disorders, including congenital heart disease, infections, head and neck trauma, prothrombotic disorders, sickle cell disease, cancer, genetic disorders, and inborn errors of metabolism, as well as autoimmune and inflammatory states [8]. However, the most important risk factors for AIS in pediatric populations are arteriopathies, congenital and acquired cardiac diseases, thrombophilia, and prothrombotic disorders [9]. Furthermore, in the literature, risk factors for recurrent AIS were also described.…”

Section: Arterial Ischemic Stroke In Childrenmentioning

confidence: 99%

The Genetic Basis of Strokes in Pediatric Populations and Insight into New Therapeutic Options

Janković

Petrović²,

Novaković

et al. 2022

IJMS

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Strokes within pediatric populations are considered to be the 10th leading cause of death in the United States of America, with over half of such events occurring in children younger than one year of life. The multifactorial etiopathology that has an influence on stroke development and occurrence signify the importance of the timely recognition of both modifiable and non-modifiable factors for adequate diagnostic and treatment approaches. The early recognition of a stroke and stroke risk in children has the potential to advance the application of neuroprotective, thrombolytic, and antithrombotic interventions and rehabilitation strategies to the earliest possible timepoints after the onset of a stroke, improving the outcomes and quality of life for affected children and their families. The recent development of molecular genetic methods has greatly facilitated the analysis and diagnosis of single-gene disorders. In this review, the most significant single gene disorders associated with pediatric stroke are presented, along with specific therapeutic options whenever they exist. Besides monogenic disorders that may present with stroke as a first symptom, genetic polymorphisms may contribute to the risk of pediatric and perinatal stroke. The most frequently studied genetic risk factors are several common polymorphisms in genes associated with thrombophilia; these genes code for proteins that are part of the coagulation cascade, fibrolysis, homocystein metabolism, lipid metabolism, or platelets. Single polymorphism frequencies may not be sufficient to completely explain the stroke causality and an analysis of several genotype combinations is a more promising approach. The recent steps forward in our understanding of the disorders underlying strokes has given us a next generation of therapeutics and therapeutic targets by which to improve stroke survival, protect or rebuild neuronal connections in the brain, and enhance neural function. Advances in DNA sequencing and the development of new tools to correct human gene mutations have brought genetic analysis and gene therapy into the focus of investigations for new therapeutic options for stroke patients.

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Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults

Cited by 19 publications

References 98 publications

Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Population-based Study Comparing Predictors of Ischemic Stroke Recurrence After Index Ischemic Stroke in Non-elderly Adults with or without Diabetes

The Genetic Basis of Strokes in Pediatric Populations and Insight into New Therapeutic Options

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