Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke: The Florida Stroke Registry

Although ischemic stroke (IS) in young patients (aged 18-55) is believed to have different etiologies than in older patients, a rise in vascular risk factors (VRFs) among young adults may translate to an IS risk profile similar to the older population. We aimed to examine the prevalence of VRFs and temporal trends in VRF burden among young patients presenting with IS.

Data were prospectively collected by Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry between January 2014 and December 2022. Patients aged 18-55 with a diagnosis of IS were included and separated into 2 age groups: 18-35 and 36-55. VRFs included hypertension, dyslipidemia, obesity, smoking, atrial fibrillation, coronary artery disease, heart failure, diabetes, and sleep apnea. Polymorbidity was defined as the presence of 3 or more VRFs.

In total, 36,488 patients with IS were included (43% female, median age 49, 51% White), comprising 3,363 patients aged 18-35 (9.2%) and 33,125 aged 36-55 (90.8%). Non-Hispanic Black patients with IS had a significantly higher prevalence of polymorbidity than non-Hispanic White or Hispanic patients among both patients aged 18-35 (18.7% vs 11.0% vs 9.8%, p < 0.001) and those aged 36-55 (40.6% vs 37.6% vs 36.9% p < 0.001). In addition, male patients were found to have a higher prevalence of polymorbidity as compared with their female counterparts (37.9% vs 34.0%, p < 0.001). VRF burden worsened across the study period, with an increase in polymorbidity from 34.6% to 41.9% in patients 36-55 (p < 0.001) and from 10.9% to 16.4% in patients 18-35 (p = 0.002).

Increasingly, young patients with stroke have traditional VRFs. The high prevalence of polymorbidity disproportionately affects non-Hispanic Black patients and male patients and has significantly increased over the past decade. Efforts targeting early identification and treatment of VRFs for primary prevention of stroke must target young populations to stem the rising tide of stroke in the young.