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Published on: August 11, 2023
Independent factors affecting hemorrhagic and ischemic stroke in patients aged 40-69 years: a cross-sectional study
Takahisa Mori1, Kazuhiro Yoshioka2, Yuhei Tanno2
1Department of Stroke Treatment, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City, Kanagawa, 247-8533, Japan. morit-koc@umin.net.
Insights
Preventable strokes like intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) in adults under 70 are linked to systolic blood pressure, HbA1c, and eicosapentaenoic acid (EPA) levels. High blood pressure and low EPA increase ICH risk, while high HbA1c indicates higher AIS risk.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Metabolic Disorders
Background:
- Intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) share vascular risk factors but differ in occurrence among adults under 70.
- The specific factors differentiating ICH and AIS subtypes in this age group remain unclear.
- Understanding these differences is crucial for stroke prevention strategies in younger adults.
Purpose of the Study:
- To identify independent variables associated with the onset of ICH versus AIS in patients aged 40-69 years.
- To determine specific risk factors that differentiate between ICH and AIS in a middle-aged population.
- To provide insights for targeted prevention of stroke subtypes.
Main Methods:
- A cohort of 40-69 year-old patients with ICH or AIS was analyzed (n=223).
- Data included age, systolic blood pressure (SBP), serum lipids, and fatty acid profiles.
- Multivariable logistic regression identified independent predictors differentiating ICH from AIS.
Main Results:
- Systolic blood pressure (SBP), glycated hemoglobin (HbA1c), and eicosapentaenoic acid (EPA) proportion were identified as independent factors.
- Higher SBP (≥158 mmHg) and lower EPA% (≤2.3%) were associated with increased ICH risk.
- Higher HbA1c (≥6.1%) was associated with increased AIS risk.
Conclusions:
- SBP, HbA1c, and EPA% are key independent factors distinguishing ICH and AIS in adults aged 40-69.
- Elevated SBP and low EPA% predict higher risk of ICH over AIS.
- Elevated HbA1c predicts higher risk of AIS over ICH, highlighting distinct risk profiles.
Background:
Intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) have common vascular risk factors; however, ICH often occurs in adults aged < 70 years. Intracerebral hemorrhage and AIS in adults aged < 70 years should be preventable; however, it is unclear why different subtypes of ICH or AIS occur among adults aged < 70 years with vascular risk factors. This study aimed to identify independent variables for ICH or AIS onset in patients aged < 70 years.
Methods:
We included patients aged 40-69 years who experienced ICH or AIS between August 2016 and July 2019. Patients aged < 40 years were excluded because other diseases, rather than vascular risk factors, are often associated with stroke etiology in this age group. Data on age, systolic blood pressure (SBP), serum lipids, and serum fatty acid levels were compared between patients with ICH and those with AIS. In addition, we conducted multivariable logistic regression analyses to identify independent factors among the variables, such as blood pressure or biomarkers, with significant differences between the two groups.
Results:
Of the 1252 acute stroke patients screened, 74 patients with ICH and 149 patients with AIS met the inclusion criteria. After excluding variables with multicollinearity, SBP, glycated hemoglobin (HbA1c), and eicosapentaenoic acid (EPA) proportion (%) of total fatty acids were identified as independent factors affecting ICH and AIS. The SBP and EPA% threshold values for ICH compared to AIS were ≥ 158 mmHg and ≤ 2.3%, respectively. The HbA1c threshold value for AIS compared to ICH was ≥ 6.1%.
Conclusions:
Systolic blood pressure, HbA1c, and EPA%, were independent factors between ICH and AIS. Patients aged 40-69 years with high SBP and low EPA% were at a higher risk of ICH than AIS, and those with a high HbA1c were at a higher risk of AIS than ICH.
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