Stroke incidence in young adults according to age, subtype, sex, and time trends

Ekker, Merel S.; Verhoeven, Jamie I; Vaartjes, Ilonca; Nieuwenhuizen, Koen M. van; Klijn, Catharina J.M.; Leeuw, Frank‐Erik de

doi:10.1212/wnl.0000000000007533

Cited by 183 publications

(197 citation statements)

References 34 publications

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“…9 The increased risk of death in men may be due to differences in risk factors and etiology between men and women (eg, higher prevalence of traditional vascular risk factors and more large-artery disease in men [28][29][30] ) as the incidence of stroke in the study period was higher in young women. 4 When compared with the general population, no significant differences between men and women in their risk of death were found.…”

Section: Discussionmentioning

confidence: 94%

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Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality

Ekker¹,

Verhoeven²,

Vaartjes

et al. 2019

JAMA

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IMPORTANCE Stroke remains the second leading cause of death worldwide. Approximately 10% to 15% of all strokes occur in young adults. Information on prognosis and mortality specifically in young adults is limited. OBJECTIVE To determine short-and long-term mortality risk after stroke in young adults, according to age, sex, and stroke subtype; time trends in mortality; and causes of death. DESIGN, SETTING, AND PARTICIPANTS Registry-and population-based study in the Netherlands of 15 527 patients aged 18 to 49 years with first stroke between 1998 and 2010, and follow-up until January 1, 2017. Patients and outcomes were identified through linkage of the national Hospital Discharge Registry, national Cause of Death Registry, and the Dutch Population Register. EXPOSURES First stroke occurring at age 18 to 49 years, documented using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes for ischemic stroke, intracerebral hemorrhage, and stroke not otherwise specified. MAIN OUTCOMES AND MEASURES Primary outcome was all-cause cumulative mortality in 30-day survivors at end of follow-up, stratified by age, sex, and stroke subtype, and compared with all-cause cumulative mortality in the general population. RESULTS The study population included 15 527 patients with stroke (median age, 44 years [interquartile range, 38-47 years]; 53.3% women). At end of follow-up, a total of 3540 cumulative deaths had occurred, including 1776 deaths within 30 days after stroke and 1764 deaths (23.2%) during a median duration of follow-up of 9.3 years (interquartile range, 5.9-13.1 years). The 15-year mortality in 30-day survivors was 17.0% (95% CI, 16.2%-17.9%). The standardized mortality rate compared with the general population was 5.1 (95% CI, 4.7-5.4) for ischemic stroke (observed mortality rate 12.0/1000 person-years [95% CI, 11.2-12.9/1000 person-years]; expected rate, 2.4/1000 person-years; excess rate, 9.6/1000 person-years) and the standardized mortality rate for intracerebral hemorrhage was 8.4 (95% CI, 7.4-9.3; observed rate, 18.7/1000 person-years [95% CI, 16.7-21.0/1000 person-years]; expected rate, 2.2/1000 person-years; excess rate, 16.4/1000 person-years). CONCLUSIONS AND RELEVANCE Among young adults aged 18 to 49 years in the Netherlands who were 30-day survivors of first stroke, mortality risk compared with the general population remained elevated up to 15 years later.

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Section: Discussionmentioning

confidence: 94%

“…[1][2][3] Approximately 10% to 15% of all strokes occur in young adults aged 18 to 49 years. 4,5 Information on the risk of death in this subgroup is limited. 6 Previous studies of mortality after stroke in young adults were often small, hospital based, had limited periods of followup, or included patients who had their stroke between 1980 and 2000.…”

mentioning

confidence: 99%

Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality

Ekker¹,

Verhoeven²,

Vaartjes

et al. 2019

JAMA

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“…A total of 50 patients between ages 18 and 50 who newly suffered ischemic stroke were consecutively recruited between September 2016 and October 2017 at the Beijing Chaoyang Hospital A liated with Capital Medical University [11]. Meanwhile, 50 age-, sex-, and body weight index (BMI)-matched healthy controls were enrolled from the Physical Examination Center at the same hospital.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Serum Metabolomic Patterns in Young Patients with Ischemic Stroke

Liu

Yuan

Zhao

et al. 2020

Preprint

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Background: Ischemic stroke is one of the leading causes of death and adult disability. The incidence of ischemic stroke continues to rise in young adults. This study aimed to provide a comprehensive evaluation of metabolic changes and explore possible mechanisms in young ischemic stroke patients without common risk factors. Methods: This study investigated serum metabolomics in 50 young patients with newly suffered ischemic stroke and 50 age-, sex-, and body mass index–matched healthy controls. The metabolomic data were analyzed by performing a multivariate statistical analysis.Results: The 197 metabolites, including amino acids, bile acids, free fatty acids, and lipids, were identified in all participants. Multivariate models showed significant differences in serum metabolomic patterns between young patients with ischemic stroke and healthy controls. The stroke patients had increased L-methionine, homocysteine, glutamine, uric acid, GCDCA, and PE (18:0/20:4, 16:0/22:5), and decreased levels of L-citrulline, taurine, PC (16:2/22:6, 16:2/20:5, 15:0/18:2), and SM (d18:1/23:0, d20:0/19:1, d18:1/22:0, d16:0/26:1, d16:0/18:0, d16:0/22:1, d18:1/19:1, d16:0/17:1, d16:1/24:1, d18:1/19:0). Based on the identified metabolites, the metabolic pathways of arginine biosynthesis, glycerophospholipid metabolism, and taurine and hypotaurine metabolism were significantly enriched in the young patients with ischemic stroke. Conclusions: Serum metabolomic patterns were significantly different between young patients with ischemic stroke and healthy controls.

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“…Age and gender are considered as two principal risk factors in many diseases such as cardiovascular disease, metabolic diseases, neurodegenerative disorders and ischemic stroke [25][26][27][28][29]. Age and gender also play important roles in the development of itch.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord NLRP1 inflammasome contributes to dry skin induced chronic itch in mice

Fan

Gao

Song

et al. 2020

J Neuroinflammation

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Background: Dry skin itch is one of the most common skin diseases and elderly people are believed to be particularly prone to it. The inflammasome has been suggested to play an important role in chronic inflammatory disorders including inflammatory skin diseases such as psoriasis. However, little is known about the role of NLRP1 inflammasome in dry skin-induced chronic itch. Methods: Dry skin-induced chronic itch model was established by acetone-ether-water (AEW) treatment. Spontaneous scratching behavior was recorded by video monitoring. The expression of nucleotide oligomerization domain (NOD)-like receptor protein 1 (NLRP1) inflammasome complexes, transient receptor potential vanilloid type 1 (TRPV1), and the level of inflammatory cytokines were determined by western blot, quantitative real-time PCR, and enzyme-linked immunosorbent assay (ELISA) kits. Nlrp1a knockdown was performed by an adeno-associated virus (AAV) vector containing Nlrp1a-shRNA-eGFP infusion. H.E. staining was used to evaluate skin lesion. Results: AEW treatment triggers spontaneous scratching and significantly increases the expression of NLRP1, ASC, and caspase-1 and the levels of IL-1β, IL-18, IL-6, and TNF-α in the spinal cord and the skin of mice. Spinal cord Nlrp1a knockdown prevents AEW-induced NLRP1 inflammasome assembly, TRPV1 channel activation, and spontaneous scratching behavior. Capsazepine, a specific antagonist of TRPV1, can also inhibit AEW-induced inflammatory response and scratching behavior. Furthermore, elderly mice and female mice exhibited more significant AEW-induced scratching behavior than young mice and male mice, respectively. Interestingly, AEW-induced increases in the expression of NLRP1 inflammasome complex and the levels of inflammatory cytokines were more remarkable in elderly mice and female mice than in young mice and male mice, respectively. Conclusions: Spinal cord NLRP1 inflammasome-mediated inflammatory response contributes to dry skin-induced chronic itch by TRPV1 channel, and it is also involved in age and sex differences of chronic itch. Inhibition of NLRP1 inflammasome may offer a new therapy for dry skin itch.

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Stroke incidence in young adults according to age, subtype, sex, and time trends

Cited by 183 publications

References 34 publications

Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality

Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality

Serum Metabolomic Patterns in Young Patients with Ischemic Stroke

Spinal cord NLRP1 inflammasome contributes to dry skin induced chronic itch in mice

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