Abstract
Objectives:We studied the prevalence of atherosclerosis among ischaemic stroke patients ≤60 years and controls at the time of the index stroke, and its association with occurrence of new cardiovascular events (CVEs) and mortality at a 5-year follow-up.Methods:Prevalent atherosclerosis was assessed for 385 patients and 260 controls in seven vascular areas by electrocardiogram (ECG), ankle–arm index (AAI) and measurement of right and left carotid and femoral intima-media thickness (cIMT and fIMT) and abdominal aorta plaques (AAP). Clinical end-points were any new CVE (stroke, angina, myocardial infarction or peripheral arterial disease) or death from any cause at 5-year follow-up. All results were sex- and age-adjusted; logistic regression and Cox proportional hazards models were applied.Results:Young patients ≤49 years had prevalent atherosclerosis in 1/2 of males and 1/3 of females. Compared with controls, young female patients showed significantly higher prevalent atherosclerosis, p = 0.024. Ischaemic ECG and mean cIMT were higher in young and middle-aged female patients (p = 0.044, p = 0.020, p = 0.023 and p <0.001, respectively). Mean fIMT was higher in middle-aged female patients (p <0.001). Cardiovascular events were associated with ischaemic ECG; AAI ≤0.9, fIMT ≥0.9 mm and increased number of areas with atherosclerosis (NAA) among patients, and with AAP, cIMT ≥0.9 mm, fIMT ≥0.9 mm and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA among patients, and cIMT ≥0.9 mm among controls.Conclusion:Atherosclerosis is highly prevalent even in young stroke patients. Some areas and increasing NAA are associated with CVEs and death.
Highlights
The 15 cities young stroke study showed smoking, dyslipidemia and hypertension as the three most frequent risk factors (RF) for cardiovascular events (CVEs), without regional differences in Europe.[1]
Combining knowledge of the high rates of recurrent CVEs and mortality in young stroke patients,[7] worst prognosis for patients with atherosclerosis,[8] high rates of cryptogenic stroke among young patients,[9] and knowledge showing that plaque instability is more important than the degree of stenosis for coronary and cerebral CVEs,[10,11] we wanted to investigate the extent of atherosclerosis in young stroke patients
large-artery atherosclerosis (LAA) was found among 28 (7.3%) of patients according to the TOAST classification (Table 4)
Summary
The 15 cities young stroke study showed smoking, dyslipidemia and hypertension as the three most frequent risk factors (RF) for cardiovascular events (CVEs), without regional differences in Europe.[1] Several European longterm young stroke studies have shown high rates of recurrent CVEs, such as ischaemic stroke (IS), angina, myocardial infarction (MI), peripheral arterial disease (PAD) and mortality mainly due to coronary atherosclerosis (CA).[2,3] Autopsy studies have shown high prevalence of CA, predominantly in young healthy male populations.[4,5]. Our hypothesis is that atherosclerosis is far more present among young and middle-aged patients than the TOAST definition of atherosclerosis with at least 50% stenosis[12] is able to show, and arterial staging is the first step to understand the extent of established artery wall disease. The aims of this study are the detailed presentation of seven predefined vascular areas at study inclusion, and their association with new CVEs and mortality at 5-year follow-up
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