Young Stroke Survivors With No Early Recurrence at High Long‐Term Risk of Adverse Outcomes

Well, I guess I don't have to worry I was 50 at my stroke. Ok they have identified a possible problem(quantify risks) but it is pretty much useless with no solution provided.  And their mentors and senior researchers allowed such useless research to go ahead.

Young Stroke Survivors With No Early Recurrence at High Long‐Term Risk of Adverse Outcomes

Jodi D. Edwards

Moira K. Kapral

M. Patrice Lindsay

Jiming Fang

Richard H. Swartz

Originally published19 Dec 2018https://doi.org/10.1161/JAHA.118.010370Journal of the American Heart Association. 2018;8:e010370

Abstract

Background

Approximately 8% to 21% of strokes affect adults aged <45 years. Although early stroke recurrence conveys the largest risk, long‐term risks for young survivors with no early complications are unclear.

Methods and Results

Longitudinal matched case‐control study (2003–2013). Consecutive patients with ischemic stroke or transient ischemic attack (young, ≤44 years) discharged from emergency or regional stroke centers in Ontario, Canada, with no death, recurrent stroke/transient ischemic attack, myocardial infarction, all‐cause hospitalization, or admission to a long‐term or continuing care facility (≤90 days) were matched 10:1 to general population controls on age (±1 year), sex, income, geography, and case date (±50 days). The primary outcome was a composite of death, stroke, myocardial infarction, and long‐term or continuing care facility admission at 1, 3, and 5 years. Absolute event rates for young stroke/transient ischemic attack patients were lower than for older patients at 1 (2.2% versus 9.9%), 3 (4.7% versus 24.6%), and 5 (7.1% versus 37.2%) years. However, piecewise constant hazard modeling revealed that, even after adjustment for vascular comorbidities, young patients showed a 7‐fold increased hazard of the composite outcome compared with young controls at 1 year (hazard ratio, 7.3; 95% CI, 4.0–13.6). Adjusted 5‐year piecewise hazard also remained >5× that of young controls (hazard ratio, 5.2; 95% CI, 2.8–9.4), compared with a 30% increase at 5 years for older patients (hazard ratio, 1.3; 95% CI, 1.3–1.4).

Conclusions

Young stable stroke/transient ischemic attack survivors show a higher long‐term hazard of adverse outcomes compared with matched controls than older patients. Findings support the need for long‐term follow‐up and aggressive risk reduction in young survivors and suggest secondary prevention guidelines for these patients are required.

Clinical Perspective

What Is New?

• This study provides new evidence that long‐term risks of major vascular events and adverse complications are elevated for young stroke survivors, even if they are clinically stable in the early high‐risk period after stroke/transient ischemic attack.

What Are the Clinical Implications?

• This work has implications for the management of young stroke/transient ischemic attack patients, supporting aggressive long‐term risk reduction, and suggests that guidelines for secondary prevention in these young high‐risk patients are required.

Introduction

Unlike the decline in ischemic stroke rates observed for the general population,¹ the incidence of stroke among young adults is increasing,² with ≈8% to 21% affecting adults aged <45 years.³ These strokes are associated with high early mortality⁴ and disability⁵ and, for working‐age adults, have a particularly significant economic impact.⁶ Although, for young patients, early recurrence after stroke or transient ischemic attack (TIA) conveys the largest risk,⁷ less is known about long‐term morbidity and mortality among stable young stroke/TIA patients who show no complications during the early high‐risk period after stroke or TIA and, specifically, whether long‐term risk returns to baseline in these patients. The purpose of this study was to quantify long‐term risks of death, major cardiovascular outcomes, and institutionalization among young stroke/TIA patients with no early complications versus young matched control adults, compared with risks for older stroke/TIA patients with no early complications compared with older matched control adults.