Mortality Risk Higher Following Early Stroke

A new study reveals that nearly one in six teens and adults who initially survive a stroke before age 50 die over the next decade.

Researchers at Helsinki University Central Hospital (HUS; Finland) conducted a study to assess the risk of mortality and recurrent stroke rate in 970 consecutive patients (15–49 years of age) that survived 30 days following a first-ever ischemic stroke. Prospective follow-up data (from 1994 to 2007) from the Finnish Care Register for Health Care and Statistics was reviewed to compare survival between clinical subgroups. Mortality ratio for demographic and pathogenetic subgroups was calculated using mortality data of the general population matched with age, sex, calendar year, and geographical area.

The results showed that at the end of follow-up, 15.7% of the patients had died, representing a cumulative risk of 23%, while 13.6% of the patients had experienced a recurrent stroke. After adjusting for baseline characteristics, recurrent stroke was statistically the most important risk factor for mortality after first-ever ischemic stroke. Observed mortality was 7-fold higher than the expected mortality, and particularly high among patients who experienced a recurrent stroke. The study was published on July 24, 2014, in Stroke.

“The high mortality rates and the striking impact of recurrent stroke on the risk of death should lead to development of more robust primary and secondary prevention strategies for young patients with stroke,” concluded lead author Karoliina Aarnio, MD, and colleagues.

The rate of stroke is increasing faster in individuals 40–60 of age than in any other age group. Although the primary causes of stroke—obesity, diabetes, high blood pressure, smoking, and excess alcohol consumption—are still primary contributors, an increasing number of strokes are related to atypical causes such as migraine, drug use, and carotid dissection. Other causes, such as congenital heart disease (CHD), patent foramen ovale (PFO), and blood clotting abnormalities, as well as family history, need to be considered in the younger population of stroke sufferers.

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