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

Overview

Journal Neurology

Specialty Neurology

Date 2025 Feb 19

PMID 39970371

Authors

Aaron Shoskes

Lili Zhou

Hao Ying

Hannah Gardener

Ayham Alkhachroum

Ruijie Yin

Gillian L Gordon Perue

David Z Rose

Angus Jameson

Antonio Bustillo

Sebastian Koch

Erika T Marulanda

Carolina Marinovic Gutierrez

Tatjana Rundek

Jose G Romano

Negar Asdaghi

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: 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.

Methods: 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.

Results: 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%, < 0.001) and those aged 36-55 (40.6% vs 37.6% vs 36.9% < 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%, < 0.001). VRF burden worsened across the study period, with an increase in polymorbidity from 34.6% to 41.9% in patients 36-55 ( < 0.001) and from 10.9% to 16.4% in patients 18-35 ( = 0.002).

Discussion: 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.

References

Tong X, George M, Gillespie C, Merritt R . Trends in hospitalizations and cost associated with stroke by age, United States 2003-2012. Int J Stroke. 2016; 11(8):874-881. PMC: 5161728. DOI: 10.1177/1747493016654490. View

Peters S, Carcel C, Millett E, Woodward M . Sex differences in the association between major risk factors and the risk of stroke in the UK Biobank cohort study. Neurology. 2020; 95(20):e2715-e2726. PMC: 7734722. DOI: 10.1212/WNL.0000000000010982. View

Mullen M, Gurol M, Prabhakaran S, Messe S, Kleindorfer D, Smith E . Hospital-Level Variability in Reporting of Ischemic Stroke Subtypes and Supporting Diagnostic Evaluation in GWTG-Stroke Registry. J Am Heart Assoc. 2023; 12(24):e031303. PMC: 10863791. DOI: 10.1161/JAHA.123.031303. View

Shay C, Ning H, Daniels S, Rooks C, Gidding S, Lloyd-Jones D . Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005-2010. Circulation. 2013; 127(13):1369-76. DOI: 10.1161/CIRCULATIONAHA.113.001559. View

Ormseth C, Sheth K, Saver J, Fonarow G, Schwamm L . The American Heart Association's Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke Vasc Neurol. 2017; 2(2):94-105. PMC: 5600018. DOI: 10.1136/svn-2017-000092. View

Rutten-Jacobs L, Arntz R, Maaijwee N, Schoonderwaldt H, Dorresteijn L, van Dijk E . Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013; 309(11):1136-44. DOI: 10.1001/jama.2013.842. View

Putaala J, Metso A, Metso T, Konkola N, Kraemer Y, Haapaniemi E . Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009; 40(4):1195-203. DOI: 10.1161/STROKEAHA.108.529883. View

Dolezsar C, McGrath J, Herzig A, Miller S . Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol. 2014; 33(1):20-34. PMC: 5756074. DOI: 10.1037/a0033718. View

Feigin V, Forouzanfar M, Krishnamurthi R, Mensah G, Connor M, Bennett D . Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383(9913):245-54. PMC: 4181600. DOI: 10.1016/s0140-6736(13)61953-4. View

10.

Adams Jr H, Bendixen B, Kappelle L, Biller J, Love B, Gordon D . Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24(1):35-41. DOI: 10.1161/01.str.24.1.35. View

11.

Gardener H, Sacco R, Rundek T, Battistella V, Cheung Y, Elkind M . Race and Ethnic Disparities in Stroke Incidence in the Northern Manhattan Study. Stroke. 2020; 51(4):1064-1069. PMC: 7093213. DOI: 10.1161/STROKEAHA.119.028806. View

12.

George M, Tong X, Bowman B . Prevalence of Cardiovascular Risk Factors and Strokes in Younger Adults. JAMA Neurol. 2017; 74(6):695-703. PMC: 5559660. DOI: 10.1001/jamaneurol.2017.0020. View

13.

Stepanikova I, Baker E, Simoni Z, Zhu A, Rutland S, Sims M . The Role of Perceived Discrimination in Obesity Among African Americans. Am J Prev Med. 2016; 52(1S1):S77-S85. PMC: 6485964. DOI: 10.1016/j.amepre.2016.07.034. View

14.

Skinner A, Ravanbakht S, Skelton J, Perrin E, Armstrong S . Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics. 2018; 141(3). PMC: 6109602. DOI: 10.1542/peds.2017-3459. View

15.

Everson-Rose S, Lutsey P, Roetker N, Lewis T, Kershaw K, Alonso A . Perceived Discrimination and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2015; 182(3):225-34. PMC: 4517694. DOI: 10.1093/aje/kwv035. View

16.

Ekker M, Verhoeven J, Vaartjes I, van Nieuwenhuizen K, Klijn C, de Leeuw F . Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019; 92(21):e2444-e2454. DOI: 10.1212/WNL.0000000000007533. View

17.

Xian Y, Fonarow G, Reeves M, Webb L, Blevins J, Demyanenko V . Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): results from a national data validation audit. Am Heart J. 2012; 163(3):392-8, 398.e1. DOI: 10.1016/j.ahj.2011.12.012. View

18.

Rosengren A, Giang K, Lappas G, Jern C, Toren K, Bjorck L . Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010. Stroke. 2013; 44(9):2388-93. DOI: 10.1161/STROKEAHA.113.001170. View

19.

Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch M . Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults. Stroke. 2017; 48(7):1744-1751. DOI: 10.1161/STROKEAHA.117.016599. View

20.

Ramirez L, Kim-Tenser M, Sanossian N, Cen S, Wen G, He S . Trends in Acute Ischemic Stroke Hospitalizations in the United States. J Am Heart Assoc. 2016; 5(5). PMC: 4889194. DOI: 10.1161/JAHA.116.003233. View