Causes of ischemic stroke in young adults versus non-young adults: A multicenter hospital-based observational study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
14
01
2022
accepted:
30
04
2022
entrez:
13
7
2022
pubmed:
14
7
2022
medline:
16
7
2022
Statut:
epublish
Résumé
Very few comparative studies have focused on the differences in the causes of ischemic stroke between young adults and non-young adults. This study was performed to determine what causes of ischemic stroke are more important in young adults than in non-young adults using a large-scale multicenter hospital-based stroke registry in Fukuoka, Japan. We investigated data on 15,860 consecutive patients aged ≥18 years with acute ischemic stroke (mean age: 73.5 ± 12.4 years, 58.2% men) who were hospitalized between 2007 and 2019. In total, 779 patients were categorized as young adults (≤50 years of age). Although vascular risk factors, including hypertension, diabetes mellitus, and dyslipidemia, were less frequent in young adults than in non-young adults, the prevalence of diabetes mellitus and dyslipidemia in young adults aged >40 years were comparable to those of non-young adults. Lifestyle-related risk factors such as smoking, drinking, and obesity were more frequent in young adults than in non-young adults. As young adults became older, the proportions of cardioembolism and stroke of other determined etiologies decreased, but those of large-artery atherosclerosis and small-vessel occlusion increased. Some embolic sources (high-risk sources: arterial myxoma, dilated cardiomyopathy, and intracardiac thrombus; medium-risk sources: atrial septal defect, nonbacterial thrombotic endocarditis, patent foramen ovale, and left ventricular hypokinesis) and uncommon causes (vascular diseases: reversible cerebral vasoconstriction syndrome, moyamoya disease, other vascular causes, arterial dissection, and cerebral venous thrombosis; hematologic diseases: antiphospholipid syndrome and protein S deficiency) were more prevalent in young adults than in non-young adults, and these trends decreased with age. Certain embolic sources and uncommon causes may be etiologically important causes of ischemic stroke in young adults. However, the contribution of conventional vascular risk factors and lifestyle-related risk factors is not negligible with advancing age, even in young adults.
Sections du résumé
BACKGROUND
Very few comparative studies have focused on the differences in the causes of ischemic stroke between young adults and non-young adults. This study was performed to determine what causes of ischemic stroke are more important in young adults than in non-young adults using a large-scale multicenter hospital-based stroke registry in Fukuoka, Japan.
METHODS AND RESULTS
We investigated data on 15,860 consecutive patients aged ≥18 years with acute ischemic stroke (mean age: 73.5 ± 12.4 years, 58.2% men) who were hospitalized between 2007 and 2019. In total, 779 patients were categorized as young adults (≤50 years of age). Although vascular risk factors, including hypertension, diabetes mellitus, and dyslipidemia, were less frequent in young adults than in non-young adults, the prevalence of diabetes mellitus and dyslipidemia in young adults aged >40 years were comparable to those of non-young adults. Lifestyle-related risk factors such as smoking, drinking, and obesity were more frequent in young adults than in non-young adults. As young adults became older, the proportions of cardioembolism and stroke of other determined etiologies decreased, but those of large-artery atherosclerosis and small-vessel occlusion increased. Some embolic sources (high-risk sources: arterial myxoma, dilated cardiomyopathy, and intracardiac thrombus; medium-risk sources: atrial septal defect, nonbacterial thrombotic endocarditis, patent foramen ovale, and left ventricular hypokinesis) and uncommon causes (vascular diseases: reversible cerebral vasoconstriction syndrome, moyamoya disease, other vascular causes, arterial dissection, and cerebral venous thrombosis; hematologic diseases: antiphospholipid syndrome and protein S deficiency) were more prevalent in young adults than in non-young adults, and these trends decreased with age.
CONCLUSIONS
Certain embolic sources and uncommon causes may be etiologically important causes of ischemic stroke in young adults. However, the contribution of conventional vascular risk factors and lifestyle-related risk factors is not negligible with advancing age, even in young adults.
Identifiants
pubmed: 35830430
doi: 10.1371/journal.pone.0268481
pii: PONE-D-22-01273
pmc: PMC9278748
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0268481Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Stroke Cerebrovasc Dis. 2016 Apr;25(4):825-30
pubmed: 26796053
J Stroke Cerebrovasc Dis. 2014 Mar;23(3):e221-7
pubmed: 24418315
Eur J Neurol. 2013 Nov;20(11):1431-9
pubmed: 23837733
Stroke. 2017 Jul;48(7):1744-1751
pubmed: 28619986
Arthritis Rheum. 2002 Apr;46(4):1019-27
pubmed: 11953980
Stroke. 2017 Jan;48(1):24-29
pubmed: 27879449
Stroke. 2009 Apr;40(4):1195-203
pubmed: 19246709
Mayo Clin Proc. 1984 Jan;59(1):17-20
pubmed: 6694427
Acta Neurol Scand. 2000 Jan;101(1):19-24
pubmed: 10660147
Eur Neurol. 2017;77(3-4):115-122
pubmed: 28052272
Nat Rev Neurol. 2017 Sep;13(9):555-565
pubmed: 28820187
Neurology. 2006 Sep 26;67(6):1050-2
pubmed: 17000975
J Am Heart Assoc. 2018 Nov 6;7(21):e009774
pubmed: 30608196
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105270
pubmed: 32992166
Neuropathology. 2000 Mar;20(1):85-90
pubmed: 10935444
Atherosclerosis. 2011 Jun;216(2):420-5
pubmed: 21354570
JAMA Neurol. 2013 Jan;70(1):51-7
pubmed: 23108720
Lancet Neurol. 2009 Jul;8(7):643-53
pubmed: 19539236
N Engl J Med. 2009 Mar 19;360(12):1226-37
pubmed: 19297575
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105087
pubmed: 32807483
N Engl J Med. 1994 Feb 10;330(6):393-7
pubmed: 8284004
J Stroke Cerebrovasc Dis. 2019 May;28(5):1261-1266
pubmed: 30772160
Cerebrovasc Dis. 2004;18(2):154-9
pubmed: 15256790
J Neurol Sci. 2020 Oct 15;417:117068
pubmed: 32745720
Eur J Neurol. 2006 Feb;13(2):146-52
pubmed: 16490045
JAMA Netw Open. 2018 Sep 7;1(5):e182953
pubmed: 30646186
Lancet Neurol. 2018 Sep;17(9):790-801
pubmed: 30129475
Stroke. 2019 Aug;50(8):1973-1980
pubmed: 31234758
Stroke. 2002 Aug;33(8):1950-5
pubmed: 12154244
Ann Neurol. 2013 Oct;74(4):592-601
pubmed: 23776015
Clin Neurol Neurosurg. 2014 May;120:78-83
pubmed: 24731581
Can J Neurol Sci. 2000 May;27(2):120-4
pubmed: 10830344
Med Sci Monit. 2019 Jan 22;25:637-642
pubmed: 30666992
J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):191-5
pubmed: 15654030
Eur J Neurol. 2010 Nov;17(11):1358-64
pubmed: 20482604
J Neurol. 2018 Aug;265(8):1943-1949
pubmed: 29680895
J Am Soc Echocardiogr. 2015 Aug;28(8):910-58
pubmed: 26239900
Cureus. 2020 Dec 14;12(12):e12083
pubmed: 33489501
J Neurol. 2015 Sep;262(9):2025-32
pubmed: 26067218
Neurology. 2013 Sep 17;81(12):1089-97
pubmed: 23946297
Neurology. 2012 Oct 23;79(17):1781-7
pubmed: 23054237
J Cereb Blood Flow Metab. 2018 Sep;38(9):1631-1641
pubmed: 28534705
Eur Neurol. 2007;57(4):212-8
pubmed: 17268202
Cerebrovasc Dis. 2020;49(6):601-608
pubmed: 33176316
Eur Heart J Suppl. 2021 Oct 08;23(Suppl E):E189-E193
pubmed: 35233215
Emerg Radiol. 2009 May;16(3):185-93
pubmed: 18830639
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
Vojnosanit Pregl. 2008 Nov;65(11):803-9
pubmed: 19069709
Lancet Neurol. 2012 Oct;11(10):906-17
pubmed: 22995694
Stroke Res Treat. 2013;2013:715380
pubmed: 23533963