Recurrence warning for young stroke patients
MedWire News: Nearly one in 10 young stroke patients will suffer a recurrence within 5 years, research shows.
"Although the overall risk is about half of that of the general stroke population, the young patients are at substantial risk of recurrent stroke, due to their much longer expected lifespan," say Jukka Putaala (Helsinki University Hospital, Finland) and colleagues.
They report, in the Annals of Neurology, that 9.4% of 807 patients who suffered a stroke before the age of 50 years had a recurrence within 5 years. In addition, 2.4% had a myocardial infarction or other vascular event, giving a combined 5-year rate of 11.5%.
Patients whose initial stroke was caused by large-artery atherosclerosis had the highest recurrence rate, at 23.3%; patients with other etiologies had 5-year recurrence rates ranging from 6.5% to 15.4%.
After accounting for confounders, initial large-artery atherosclerotic stroke increased recurrence risk 2.82-fold, while previous transient ischemic attack (TIA) and the presence of heart failure raised this risk 2.33- and 2.96-fold, respectively. Each 1-year increase in age raised recurrence risk by 5%.
But the strongest risk factor for recurrence was the presence of Type 1 diabetes, which increased recurrence risk 4.39-fold.
The researchers say that the predictive power of diabetes and TIA for recurrent stroke probably reflects "underlying high-risk vascular disease."
They say: "The prognostic robustness of particularly Type 1 diabetes - and not least because of its fast increasing incidence - should lead to further studies aiming to reduce the recurrence risk in these patients by meticulous secondary prevention."
Recurrence risk rose with increasing numbers of risk factors; however, Putaala et al note that about 5% of patients with no established risk factors also suffered a recurrence.
"Whether or what secondary preventive medication should be used in these patients remains to be elucidated," they say.
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By Eleanor McDermid