Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes

Area of Science:

• Neurology
• Cardiology
• Public Health

Background:

• Acute Ischemic Stroke (AIS) in young adults is rising, with cryptogenic strokes being the most common subtype.
• Current methods for defining cryptogenic stroke and its risk factors require refinement to address this growing trend.

Purpose of the Study:

• To investigate the presence and patterns of cardiovascular risk factors in cryptogenic stroke cases among young adults.
• To develop and apply clinical risk phenotype models for better classification of cryptogenic strokes.

Main Methods:

• Retrospective cohort study of 449 patients aged 18-49 with AIS at an urban tertiary care center.
• Manual collection of demographic, clinical, laboratory, and radiological data.
• Multivariate analysis to define vascular (small/large vessel disease) and cardiac (cardioembolic) phenotypes, then applied to cryptogenic cases.

Main Results:

• Patients with the vascular phenotype showed higher rates of hypertension, intracranial atherosclerosis, diabetes, and elevated lipids/glucose.
• Patients with the cardiac phenotype had higher rates of heart failure, atrial fibrillation, clotting disorders, and cardiac biomarkers.
• Independent predictors for vascular phenotype included age, male sex, HbA1c, LDL cholesterol, and family history; for cardiac phenotype: age, female sex, reduced ejection fraction, CHF, and absence of intracranial atherosclerosis.

Conclusions:

• Applying phenotype models to cryptogenic strokes revealed 51.5% fit the vascular profile and 3.1% the cardiac profile.
• A significant portion of young cryptogenic stroke patients exhibit risk factor profiles associated with small and large vessel disease.