Recurrent ischemic stroke in young adults: A multicenter cohort study, systematic review, and meta-analysis
Gabriel Yi Ren Kwok1, Ryan Wei Rong Chen2, Tasha Anna Leow3
1Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Summary
Young adults experiencing ischemic stroke (IS) face a significant long-term risk of recurrence. Key factors like diabetes and prior stroke increase this risk, highlighting the need for further research.
Area of Science:
- Neurology
- Cardiovascular Research
- Public Health
Background:
- Recurrent ischemic stroke (IS) significantly impacts young adults, causing substantial morbidity and mortality.
- Limited data exist for this critical demographic, despite the growing importance of recurrent stroke.
- Understanding recurrence patterns in young adults is crucial for effective management and prevention strategies.
Purpose of the Study:
- To characterize the rates and prognostic factors associated with recurrent ischemic stroke in young adults.
- To provide a comprehensive overview of recurrent stroke risk in this population through a combined cohort study and meta-analysis.
Main Methods:
- Retrospective multicenter cohort study of 845 acute ischemic stroke patients aged 18-50 years.
- Systematic review and meta-analysis of 31 studies (18,955 patients) from 2000-2024, searching PubMed, Embase, Scopus, and Cochrane databases.
- Analysis of recurrence rates and associated factors using univariate/multivariable Cox models and meta-analysis of survival data.
Main Results:
- The cohort study revealed a 1-year recurrence rate of 3.41% for ischemic stroke in young adults.
- Meta-analysis of 31 studies indicated 1-year recurrence rates of 4.5-7.3%, increasing to 14.0-20.3% over >10 years.
- Diabetes mellitus, prior stroke/TIA, large artery atherosclerosis, and hypertension were significantly associated with recurrent cerebrovascular events.
Conclusions:
- Young adults with ischemic stroke have a substantial long-term risk of recurrent cerebrovascular events.
- Factors such as diabetes, hypertension, and prior stroke history are critical predictors of recurrence.
- Further prospective studies are essential to better define the long-term prognosis and optimize management for young adults post-stroke.
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