Introduction: Ischemic stroke (IS) in the young portends a high mortality and morbidity. IS in this population has etiologies that differ from that of the older and carries unique risk factors (RF) that may predict recurrence.
Objectives: We aimed to determine the demographic, medical and social RF that are associated with recurrence of IS in patients with a sentinel event prior to the age of 50.
Methods: This is a single center case control study conducted between Jan 2009 and May 2017. All patients with IS <50 years of age who survived were evaluated for recurrence. Demographics, laboratories, medical and social history were obtained through chart review. Independent T tests were applied for continuous variables and Chi Squared or Fisher’s exact test for categorical variables. Cox regression analysis was used to determine variables associated with recurrence. A p-value of <0.05 was considered significant.
Results: A total of 875 patients under age 50 were found to have IS. After a follow up of (mean ± SD) 1385 ± 880 days, a total of 90 (10%) patients suffered at least one recurrence at 560 ± 723 days post-discharge (range 3-2480 days). History of diabetes, drug abuse and smoking were found to be significantly different between the controls and recurrence groups (p = 0.001, p = 0.004, p = 0.021; respectively). Univariate predictors of recurrence included black race (Hazard Ratio [HR] 1.68, p = 0.023), history of diabetes (HR 2.04, p = 0.002), drug abuse (HR 2.73, p < 0.001), smoking (HR 1.70, p = 0.013), and HbA1c (HR 1.15 per 1% increase, p < 0.001). All non-demographic predictors remained significant when normalized for age, race and gender. Multivariate regression found history of diabetes, drug abuse and smoking to be predictive of recurrence (HR of 1.96, p = 0.026; 2.25, p = 0.004; 1.63, p = 0.04; respectively). Recurrence occurred in 5/12 (42%) patients positive for all three RF versus 22/333 (7%) that are devoid of the above RF.
Conclusions: In summary, stroke in the young recurrence rate was 10% in our study population. History of diabetes, drug abuse, and smoking were found to be associated with recurrence suggesting that risk factor modification is important. Larger cohort studies are needed to further validate these findings..