The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study

Abstract

Introduction: Patients who suffer a stroke at a young age, remain at a substantial risk of developing recurrent vascular events and information on very long-term prognosis and its risk factors is indispensable. Our aim is to investigate this very long-term risk and associated risk factors up to 35 years after stroke. Patients and methods: Prospective cohort study among 656 patients with a first-ever ischaemic stroke or transient ischaemic stroke (TIA), aged 18-50, who visited our hospital (1980-2010). Outcomes assessed at follow-up (2014-2015) included TIA or ischaemic stroke and other arterial events, whichever occurred first. Kaplan-Meier analysis quantified cumulative risks. A prediction model was constructed to assess risk factors independently associated with any ischaemic event using Cox proportional hazard analyses followed by bootstrap validation procedure to avoid overestimation. Results: Mean follow-up was 12.4 (SD 8.2) years (8105 person-years). Twenty-five years cumulative risk was 45.4% (95%CI: 39.4-51.5) for any ischaemic event, 30.1% (95%CI: 24.8-35.4) for cerebral ischaemia and 27.0% (95%CI: 21.1-33.0) for other arterial events. Risk factors retained in the prediction model were smoking (HR 1.35, 95%CI: 1.04-1.74), poor kidney function (HR 2.10, 95%CI: 1.32-3.35), history of peripheral arterial disease (HR 2.10, 95%CI: 1.08-3.76) and cardiac disease (HR 1.84, 95%CI: 1.06-3.18) (C-statistic 0.59 (95%CI: 0.55-0.64)). Discussion and conclusion: Young stroke patients remain at a substantial risk for recurrent events; almost 1 of 2 develops a recurrent ischaemic event and 1 of 3 develops a recurrent stroke or TIA during 25 years of follow-up. Risk factors independently associated with recurrent events were poor kidney function, smoking, history of peripheral arterial disease and cardiac disease.

Risk factors and mechanisms of stroke in young adults: The FUTURE study

“… 1 , 2 These young individuals, who are often in a period of life during which important decisions on starting a family or a career are being made, remain at high risk for recurrent stroke. 3 As these patients generally still have a life expectancy of decades ahead, knowledge of risk factors and causes of stroke is essential to inform them on the cause of the disease and to possibly prevent future vascular disease. Despite the ever increasing number of young stroke patients, the risk factors and causes of stroke remain unknown in about one-third of all patients, 4 partly because of the tendency to classify them according to classification systems developed for elderly stroke patients, for example the TOAST classification.…”

Prothrombotic factors do not increase the risk of recurrent ischemic events after cryptogenic stroke at young age: the FUTURE study

“…Cardiovascular risk factors at baseline were defined as either a history of a risk factor (mentioned in medical history or the use of medication) or detected during admission or analysis of the stroke [ 19 ].…”

“…Follow-up assessment took place from 2009 to 2012 and subsequently from August 2014 to January 2015. In case information from the last follow-up assessment was missing, data from the previous follow-up were used [ 19 ]. Patients alive underwent a structured interview to evaluate for recurrent events.…”

Evaluation of clinical spectrum and risk factors in young stroke patients at a tertiary level hospital, Patna, Bihar

“…Young smokers (15-45 years old) had 1.6 times the risk of cerebral infarction as non-smokers. 3 Apart from hypertension, dyslipidemia, and diabetes, transient ischemic attack and family history of stroke were substantial risk factors. In a research from north India, the main risk factors were hypertension, hyperglycemia, and cigarette use with low haemoglobin levels.…”