Temporal Trends in the Risk Factors and Clinical Characteristics of Ischemic Stroke in Young Adults

Abstract

This study aimed to analyze the risk factors of ischemic stroke in young adults of different ages; explore the changes in these risk factors with time; analyze the clinical characteristics of ischemic stroke in young adults; and assess how to better prevent ischemic stroke in young adults. All patients with ischemic stroke who presented to the Department of Emergency Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School were enrolled. The data of patients aged 18-50 years were retrospectively evaluated for two periods, January-December 2008 and January-December 2018. Additionally, we collected the data of patients aged 51-90 years with ischemic stroke in the same ward in 2018. The subjects were divided into three groups: ischemic stroke in young people in 2008 ("Youth 2008"), ischemic stroke in young people in 2018 ("Youth 2018"), and ischemic stroke in elderly people in 2018 ("Senior 2018"). Risk factors, clinical characteristics and test indices were recorded and analyzed statistically. The "Youth 2008" group included 28 patients-19 males (67.9%) and 9 females (31.2%) with a male-to-female ratio of 2.11:1. The "Youth 2018" group included 23 patients-20 males (87.0%) and 3 females (13.0%) with a male-to-female ratio of 6.67:1. The "Senior 2018" group included 210 patients-150 males (71.4%) and 60 females (28.6%) with a male-to-female ratio of 2.50:1. The risk factors in "Youth 2018" were higher than those in "Youth 2008" in terms of hypertension, hyperglycemia, and hypercholesterolemia without significant difference. Smoking and hypertrophic cardiomyopathy were significantly increased (P<0.05) in this population. Smoking, hypercholesterolemia, and hypertrophic cardiomyopathy were more prevalent among the "Youth 2018" group than among the "Senior 2018" group, whereas carotid plaques, hypertension, and atrial fibrillation were less common in the younger group (P<0.05). There was no significant difference between the younger and older groups in terms of thrombolysis rate, cerebral infarction type, and complications, except pulmonary infections (P<0.05). There was no significant change in the main risk factors of ischemic stroke in young adults during the 10-year period. Traditional risk factors-smoking and hypertrophic cardiomyopathy-were still common but with a significantly greater prevalence, whereas carotid plaques, hypertension, and atrial fibrillation had become less common. The clinical characteristics, other than pulmonary infection, were not significantly different between the younger and older patients with ischemic stroke.