Risk factor burden predicts long-term mortality in young patients with arterial cerebral infarction
H Naess1, U Waje-Andreassen, H Nyland
1Department of Neurology, Haukeland University Hospital, Bergen, Norway. haln@haukeland.no
Acta Neurologica Scandinavica
|May 24, 2012
Summary
Young adults experiencing arterial cerebral infarction face increased long-term mortality risk with more traditional risk factors. Aggressive secondary prevention is crucial for those with multiple risk factors.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Arterial cerebral infarction in young adults (<50 years) presents unique challenges for long-term prognosis.
- Understanding the cumulative impact of traditional risk factors on mortality is essential for effective patient management.
Purpose of the Study:
- To investigate the independent and combined effects of traditional risk factors on long-term mortality following arterial cerebral infarction in young adults.
- To identify specific risk factors associated with increased mortality in this demographic.
Main Methods:
- A population-based cohort study of young adults (<50 years) with a first-ever arterial ischemic stroke.
- Utilized Cox regression analyses to assess mortality risk associated with the number and type of risk factors (smoking, hypertension, hypercholesterolemia, diabetes mellitus, myocardial infarction, angina pectoris, intermittent claudication, alcoholism).
- Mean follow-up duration of 18 years, representing the longest follow-up in studies of young adults post-cerebral infarction.
Main Results:
- Mortality rates significantly increased with the number of risk factors: 12.5% (no risk factors) vs. 18.5% (1-3 risk factors) vs. 25.4% (4-5 risk factors) vs. 53.1% (≥6 risk factors) (P < 0.001).
- The cumulative number of risk factors was significantly associated with mortality (Hazard Ratio [HR] = 1.6, P = 0.001).
- Individual risk factors strongly linked to mortality included diabetes mellitus (HR = 3.0, P = 0.001), myocardial infarction (HR = 3.1, P = 0.001), and alcoholism (HR = 6.3, P < 0.001).
Conclusions:
- An increasing burden of traditional cardiovascular risk factors is significantly associated with long-term mortality in young adults who have experienced a cerebral infarction.
- These findings underscore the critical need for intensified and tailored long-term secondary preventive strategies in young stroke survivors, particularly those with multiple risk factors.
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