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Abstract
Objectives: To study the long-term risk of recurrent cardiac, arterial, and venous events in young stroke patients, and whether these risks differed between etiologic subgroups.
Methods: The study population comprised 970 patients aged 15–49 years from the Helsinki Young Stroke Registry (HYSR) who had an ischemic stroke in 1994–2007. We obtained follow-up data until 2012 from the Finnish Care Register and Statistics Finland. Cumulative 15-year risks were analyzed with life tables, whereas relative risks and corresponding confidence intervals (CI) were based on hazard ratios (HR) from Cox regression analyses.
Results: There were 283 (29.2%) patients with a cardiovascular event during the median follow-up of 10.1 years (range 0.1–18.0). Cumulative 15-year risk for venous events was 3.9%. Cumulative 15-year incidence rate for composite vascular events was 34.0 (95% CI 30.1–38.2) per 1,000 person-years. When adjusted for age and sex, patients with an index stroke caused by high-risk sources of cardioembolism had the highest HR for any subsequent cardiovascular events (3.7; 95% CI 2.6–5.4), whereas the large-artery atherosclerosis group had the highest HR (2.7; 95% CI 1.6–4.6) for recurrent stroke compared with patients with stroke of undetermined etiology.
Conclusions: The risk for future cardiovascular events after ischemic stroke in young adults remains high for years after the index stroke, in particular when the index stroke is caused by high-risk sources of cardioembolism or large-artery atherosclerosis.
GLOSSARY
- ACS=
- acute coronary syndromes;
- CEH=
- high-risk sources of cardioembolism;
- CEL=
- low-risk sources of cardioembolism;
- CI=
- confidence interval;
- CVD=
- cardiovascular disease;
- DVT=
- deep vein thrombosis;
- HUCH=
- Helsinki University Central Hospital;
- HR=
- hazard ratio;
- HYSR=
- Helsinki Young Stroke Registry;
- ICD=
- International Classification of Diseases;
- IS=
- ischemic stroke;
- LAA=
- large-artery atherosclerosis;
- MI=
- myocardial infarction;
- PE=
- pulmonary embolism;
- ROD=
- rare causes other than dissection;
- SVO=
- small vessel occlusion;
- TOAST=
- Trial of Org 10172 in Acute Stroke Treatment;
- UND=
- undetermined etiology;
- VAD=
- vertebral artery dissection
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received October 12, 2015.
- Accepted in final form February 2, 2016.
- © 2016 American Academy of Neurology
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