Insights into the vascular aging burden in young adults with embolic stroke of undetermined source

This study investigates pre-atherosclerotic changes, vascular aging and clinical cardiovascular disease (CVD) risk scores in young adults with embolic stroke of undetermined source (ESUS) compared to stroke-free controls.

The study included 105 ESUS patients and 105 age- and sex-matched stroke-free controls aged 18 to 49 years. Clinical and laboratory characteristics and arterial stiffness measurements were recorded. Vascular aging indexes were defined according to age-adapted values and definitions. Clinical scores PREVENT and SCORE2 were calculated. Associations were investigated using logistic regression adjusting for several factors associated with vascular aging.

Young ESUS patients had higher rates of central obesity, smoking, heavy alcohol consumption and patent foramen ovale compared to stroke-free controls. ESUS patients had higher odds of having excessive intima-media thickness (IMT) of the right carotid artery (OR 3.02, 95 %CI:1.31-6.92). They also had significantly higher odds of having elevated estimated pulse wave velocity (ePWV>9 m/s; OR 8.48, 95 %CI:2.16-33.4), high pulse pressure (PP ≥ 60 mmHg; OR 3.13, 95 %CI:1.28-7.68), a 10-year CVD risk above 5 % based on the PREVENT score (OR 8.53, 95 %CI:1.59-45.7), and a 10-year CVD risk above 2.5 % based on SCORE2 (OR 26.5, 95 %CI:3.6-193.6) estimated at the time of their stroke.

Despite a low burden of established CVD, young ESUS patients harbored pathology in the vascular aging measures including IMT, ePWV, and PP. Clinical risk scores such as PREVENT and SCORE2 may effectively identify young adults at high risk of developing ESUS.