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  • Review Article
  • Published:

Ischaemic stroke in young adults: risk factors and long-term consequences

A Corrigendum to this article was published on 07 October 2014

This article has been updated

Key Points

  • Traditional vascular risk factors are more common in young patients with stroke—especially those over 35 years of age—than was previously thought; thus, 'young' stroke increasingly resembles 'old' stroke

  • Long-term secondary prevention after stroke seems as important in young adults as in older individuals, although trials are needed to establish which patients will benefit from different treatment strategies

  • Poor functional outcome and psychosocial problems are common among young patients (under 50 years of age) with stroke

  • The long-term prevalence of psychosocial consequences, and their influence on daily life, must be further investigated, so as to optimize specific rehabilitation programmes for young patients with stroke

Abstract

Contrary to trends in most other diseases, the average age of ischaemic stroke onset is decreasing, owing to a rise in the incidence of stroke among 'young' individuals (under 50 years of age). This Review provides a critical overview of the risk factors and aetiology of young ischaemic stroke and addresses its long-term prognosis, including cardiovascular risk, functional outcome and psychosocial consequences. We highlight the diminishing role of 'rare' risk factors in the pathophysiology of young stroke in light of the rising prevalence of 'traditional' vascular risk factors in younger age groups. Long-term prognosis is of particular interest to young patients, because of their long life expectancy and major responsibilities during a demanding phase of life. The prognosis of young stroke is not as favourable as previously thought, with respect either to mortality or cardiovascular disease or to psychosocial consequences. Therefore, secondary stroke prevention is probably a life-long endeavour in most young stroke survivors. Due to under-representation of young patients in past trials, new randomized trials focusing on this age group are needed to confirm the benefits of long-term secondary preventive medication. The high prevalence of poor functional outcome and psychosocial problems warrants further study to optimize treatment and rehabilitation for these young patients.

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Figure 1: Prevalence of traditional vascular risk factors in young patients with stroke according to age and sex.
Figure 2: Age-specific proportions of patients with traditional vascular risk factors, stratified by sex.
Figure 3: Long-term cumulative mortality in young patients with stroke and the general population with similar age, sex and calendar-year characteristics.
Figure 4: Risk of death or recurrent vascular events stratified by number of traditional vascular risk factors.

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Bruce C. V. Campbell, Deidre A. De Silva, … Geoffrey A. Donnan

Change history

  • 07 October 2014

    In Figure 3 of the originally published article, the x-axis label was incorrect: it should read 'Follow-up duration (years)'. This error has been corrected in the HTML and PDF versions of the article.

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Acknowledgements

F.-E.d.L. received funding from the Dutch Epilepsy Fund (grant 10-18). Also, this work was supported by a Vidi innovational grant from the Dutch Organization for Scientific Research (grant 016.126.351). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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N.A.M.M.M. and L.C.A.R.-J. contributed equally to this article. N.A.M.M.M., L.C.A.R.-J. and F.-E.d.L. researched the data for the article and wrote the text. N.A.M.M.M., L.C.A.R.-J., E.J.v.D. and F.-E.d.L. provided substantial contributions to discussions of the content. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Frank-Erik de Leeuw.

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Maaijwee, N., Rutten-Jacobs, L., Schaapsmeerders, P. et al. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 10, 315–325 (2014). https://doi.org/10.1038/nrneurol.2014.72

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