Midlife Stroke Heralds Recurrent Vascular Events

Patients who suffer a stroke or transient ischemic attack (TIA) by age 50 remain at substantial risk of recurrent vascular events for decades, according to a new study.

Researchers at Radboud University Nijmegen Medical Center (Nijmegen, The Netherlands) conducted a study that prospectively included 724 consecutive patients (aged 18 to 50 years) with a first-ever TIA, ischemic stroke, or intracerebral hemorrhage (ICH), admitted to the hospital between January 1, 1980, and November 1, 2010. The main outcome measures were stroke, myocardial infarction (MI), the need for cardiac or peripheral arterial revascularization procedures, or a composite event, whichever occurred first.

The results showed that after a mean follow-up of 9.1 years, 142 patients (19.6%) had at least one recurrent vascular event. The cumulative 20-year risk of stroke was 17.3% after TIA, 19.4% after ischemic stroke, and 9.8% after ICH. The cumulative 20-year risk of any vascular event was 27.7% after TIA and 32.8% after ischemic stroke. Age and male sex were associated with other arterial events, but not with stroke. Adjustment for age, sex, and decennium of inclusion showed that atherothrombotic stroke, cardioembolic stroke, and lacunar stroke were associated with recurrent stroke. The study was published in the October 2013 issue of Annals of Neurology.

“Patients with young stroke remain at substantial risk of recurrent vascular events for decades, suggesting that the underlying disease that caused stroke at a young age continues to put these patients at a high risk for vascular disease throughout their lives,” concluded lead author Frank-Erik de Leeuw, MD, PhD, and colleagues of the department of neurology.

The study follows a previous one by the same authors published in the March 20, 2013, issue of the Journal of the American Medical Association (JAMA), which found that adults who initially survived a stroke or TIA faced mortality rates of up to 3% at one year, 12% at 10 years, and 27% at 20 years, representing a 2.6- to 3.9-fold increase in mortality risk than that of a matched general population that did not suffer a stroke by age 50.

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Radboud University Nijmegen Medical Center