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Erschienen in: Current Cardiology Reports 12/2013

01.12.2013 | Stroke (C Sila, Section Editor)

The Growing Problem of Stroke among Young Adults

Erschienen in: Current Cardiology Reports | Ausgabe 12/2013

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Abstract

Although overall stroke incidence has been declining in developed countries, there is evidence that stroke in the young is increasing. Increasing incidence may be particularly pronounced among minorities in whom historically a higher burden of stroke has been reported. Compared with older adults, time spent with disability is longer for those affected at younger ages, and new data suggests that among 30-day young adult stroke survivors, increased mortality persists for as long as 20 years. Stroke in young adults is often missed by less experienced clinicians due to its unexpectedness, leading to lost opportunities for intervention. The causes and risk factors for stroke in the young are often rare or undetermined, but young adults with stroke also have a high burden of traditional cardiovascular risk factors, including hypertension, diabetes, obesity, and substance abuse. Disseminating awareness and promoting research on young adult stroke are steps towards reducing the burden of stroke.
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Zurück zum Zitat • Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012;366:2257–66. This is a 15-year population based cohort study on risk of thrombotic stroke and myocardial infarction among young women (15–49 years) with no history of cardiovascular disease. Use of all hormonal contraceptions was associated with a small increased risk of an outcome event.PubMedCrossRef • Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012;366:2257–66. This is a 15-year population based cohort study on risk of thrombotic stroke and myocardial infarction among young women (15–49 years) with no history of cardiovascular disease. Use of all hormonal contraceptions was associated with a small increased risk of an outcome event.PubMedCrossRef
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Zurück zum Zitat Petitti DB. Hormonal contraceptives and arterial thrombosis–not risk-free but safe enough. N Engl J Med. 2012;366:2316–8.PubMedCrossRef Petitti DB. Hormonal contraceptives and arterial thrombosis–not risk-free but safe enough. N Engl J Med. 2012;366:2316–8.PubMedCrossRef
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Zurück zum Zitat • Thaler DE, Ruthazer R, Di Angelantonio E, Di Tullio MR, Donovan JS, Elkind MS, et al. Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale. Stroke. 2013;44:675–80. This international collaborative individual patient meta-analysis draws on data from 12 component databases to study the association between imaging characteristics of stroke and the likelihood of finding a PFO. The investigators found that patients with strokes that were large, radiologically apparent, superficially located, or unassociated with prior radiological infarcts were more likely to have PFOs than were those with unapparent, smaller, or deep strokes, or those with other chronic infarcts.PubMedCrossRef • Thaler DE, Ruthazer R, Di Angelantonio E, Di Tullio MR, Donovan JS, Elkind MS, et al. Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale. Stroke. 2013;44:675–80. This international collaborative individual patient meta-analysis draws on data from 12 component databases to study the association between imaging characteristics of stroke and the likelihood of finding a PFO. The investigators found that patients with strokes that were large, radiologically apparent, superficially located, or unassociated with prior radiological infarcts were more likely to have PFOs than were those with unapparent, smaller, or deep strokes, or those with other chronic infarcts.PubMedCrossRef
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Zurück zum Zitat • Kent DM RR, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, et al. The Risk of Paradoxical Embolism (RoPE) Study: a score to identify cryptogenic stroke patients whose stroke is likely attributable to patent foramen ovale. Neurology. [In press]. This paper describes the development of the Risk of Paradoxical Embolism (RoPE) score, a simple 10 point scoring system for use among patients with unexplained stroke. Variables negatively associated with a PFO in patients with unexplained stroke included age, diabetes, hypertension, smoking, prior stroke or TIA, and absence of a cortical stroke on neuroimaging. The 10-point RoPE score includes a point for each of the 5 non-age factors and 1 point for roughly each full decade over age 18 (up to 5 points). Patients with higher scores (ie, fewer risk factors) were more likely to have PFOs, but were also less likely to have a stroke recurrence. These data and the scoring system may be useful in future trials of PFO closure. • Kent DM RR, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, et al. The Risk of Paradoxical Embolism (RoPE) Study: a score to identify cryptogenic stroke patients whose stroke is likely attributable to patent foramen ovale. Neurology. [In press]. This paper describes the development of the Risk of Paradoxical Embolism (RoPE) score, a simple 10 point scoring system for use among patients with unexplained stroke. Variables negatively associated with a PFO in patients with unexplained stroke included age, diabetes, hypertension, smoking, prior stroke or TIA, and absence of a cortical stroke on neuroimaging. The 10-point RoPE score includes a point for each of the 5 non-age factors and 1 point for roughly each full decade over age 18 (up to 5 points). Patients with higher scores (ie, fewer risk factors) were more likely to have PFOs, but were also less likely to have a stroke recurrence. These data and the scoring system may be useful in future trials of PFO closure.
59.
Zurück zum Zitat • Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al. Closure of patent foramen ovale vs medical therapy after cryptogenic stroke. N Engl J Med. 2013;368:1092–100. This is a recent randomized clinical trial comparing closure of a patent foramen ovale with medical therapy among young adults (18–60) with a cryptogenic stroke. For the primary outcome of stroke recurrence, there was no statistically significant difference between the groups, but the study may have been underpowered. Adverse events were similar between the groups.PubMedCrossRef • Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al. Closure of patent foramen ovale vs medical therapy after cryptogenic stroke. N Engl J Med. 2013;368:1092–100. This is a recent randomized clinical trial comparing closure of a patent foramen ovale with medical therapy among young adults (18–60) with a cryptogenic stroke. For the primary outcome of stroke recurrence, there was no statistically significant difference between the groups, but the study may have been underpowered. Adverse events were similar between the groups.PubMedCrossRef
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Zurück zum Zitat • Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013;368:1083–91. Another recent randomized clinical trial comparing closure of a patent foramen ovale with medical therapy, this trial included adults <60 years with an ischemic stroke, TIA, or a peripheral thromboembolic event. The rate of a primary outcome event (death, nonfatal stroke, TIA, or peripheral embolism) was not statistically different in the closure and the medical-therapy groups, but this study also may have been underpowered.PubMedCrossRef • Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013;368:1083–91. Another recent randomized clinical trial comparing closure of a patent foramen ovale with medical therapy, this trial included adults <60 years with an ischemic stroke, TIA, or a peripheral thromboembolic event. The rate of a primary outcome event (death, nonfatal stroke, TIA, or peripheral embolism) was not statistically different in the closure and the medical-therapy groups, but this study also may have been underpowered.PubMedCrossRef
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Zurück zum Zitat Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35:664–70.PubMedCrossRef Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35:664–70.PubMedCrossRef
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Zurück zum Zitat Saposnik G, Barinagarrementeria F, Brown Jr RD, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.PubMedCrossRef Saposnik G, Barinagarrementeria F, Brown Jr RD, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.PubMedCrossRef
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Zurück zum Zitat Kuruvilla A, Bhattacharya P, Rajamani K, Chaturvedi S. Factors associated with misdiagnosis of acute stroke in young adults. J Stroke Cerebrovasc Dis. 2011;20:523–7.PubMedCrossRef Kuruvilla A, Bhattacharya P, Rajamani K, Chaturvedi S. Factors associated with misdiagnosis of acute stroke in young adults. J Stroke Cerebrovasc Dis. 2011;20:523–7.PubMedCrossRef
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Zurück zum Zitat Niinikoski H, Lagstrom H, Jokinen E, Siltala M, Ronnemaa T, Viikari J, et al. Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins: the STRIP study. Circulation. 2007;116:1032–40.PubMedCrossRef Niinikoski H, Lagstrom H, Jokinen E, Siltala M, Ronnemaa T, Viikari J, et al. Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins: the STRIP study. Circulation. 2007;116:1032–40.PubMedCrossRef
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Zurück zum Zitat Niinikoski H, Jula A, Viikari J, Ronnemaa T, Heino P, Lagstrom H, et al. Blood pressure is lower in children and adolescents with a low-saturated-fat diet since infancy: the special turku coronary risk factor intervention project. Hypertension. 2009;53:918–24.PubMedCrossRef Niinikoski H, Jula A, Viikari J, Ronnemaa T, Heino P, Lagstrom H, et al. Blood pressure is lower in children and adolescents with a low-saturated-fat diet since infancy: the special turku coronary risk factor intervention project. Hypertension. 2009;53:918–24.PubMedCrossRef
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Zurück zum Zitat Pahkala K, Hietalampi H, Laitinen TT, Viikari JS, Ronnemaa T, Niinikoski H, et al. Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the STRIP Study). Circulation. 2013;127(21):2088–96. Pahkala K, Hietalampi H, Laitinen TT, Viikari JS, Ronnemaa T, Niinikoski H, et al. Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the STRIP Study). Circulation. 2013;127(21):2088–96.
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Metadaten
Titel
The Growing Problem of Stroke among Young Adults
Publikationsdatum
01.12.2013
Erschienen in
Current Cardiology Reports / Ausgabe 12/2013
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-013-0421-z

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