November 16, 2018
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AF, CVD, diabetes strong risk factors for early ischemic stroke

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Atrial fibrillation, CVD and type 1 or 2 diabetes were strong risk factors for early-onset ischemic stroke, according to a case-control analysis.

Reetta Kivioja, MD, from the department of clinical neurosciences at the University of Helsinki and department of neurology at Helsinki University Hospital, and colleagues compared 961 patients who had a first ischemic stroke at age 25 to 49 years with 1,403 frequency-matched controls who had never had a stroke. All were participants in the FINRISK population-based cohort study.

The researchers assessed whether 11 vascular risk factors conferred elevated risk for ischemic stroke at a young age.

After multivariable logistic regression analysis, Kivioja and colleagues found the following eight risk factors were linked to excess risk for early ischemic stroke:

  • AF (adjusted OR = 10.43; 95% CI, 2.33-46.77);
  • CVD (aOR = 8.01; 95% CI, 3.09-20.78);
  • type 1 diabetes (aOR = 6.72; 95% CI, 3.15-14.33);
  • type 2 diabetes (aOR = 2.31; 95% CI, 1.35-3.95);
  • low HDL (aOR = 1.81; 95% CI, 1.37-2.4);
  • current smoking status (aOR = 1.81; 95% CI, 1.5-2.17);
  • hypertension (aOR = 1.43; 95% CI, 1.17-1.75); and
  • family history of stroke (aOR = 1.37; 95% CI, 1.04-1.82).

High LDL had an inverse relationship with early-onset ischemic stroke (aOR = 0.51; 95% CI, 0.42-0.62), whereas high triglycerides and active malignancy had no significant relationship with early-onset ischemic stroke, according to the researchers.

“Although our study cannot establish causality, at the very least this finding indicates that high LDL-C does not play a role in the [ischemic stroke] pathogenic mechanisms that occur more frequently among younger patients,” the researchers wrote. “Furthermore, low cholesterol could merely represent a confounder reflecting an underlying susceptibility factor for early-onset [ischemic stroke].”

In subgroup analyses, the most consistent associations with early-onset ischemic stroke occurred with type 1 diabetes and current smoking status, Kivioja and colleagues wrote.

“Our results showed stronger associations than expected for AF, CVD and both types of diabetes mellitus,” Kivioja and colleagues wrote. “Given these findings, a new hypothesis emerges suggesting that these comorbidities may represent more aggressive forms of disease predisposing individuals to a severe vascular endpoint early in life.” – by Erik Swain

Disclosures: Kivioja reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.