Risk factors, etiology, and outcome of ischemic stroke in young adults: A Japanese multicenter prospective study
Introduction
Ischemic stroke (IS) is a major cause of death and disability in Japan and worldwide [1]. Most IS patients are generally over 75 years of age. Approximately 10–20% of IS occurs in young adults aged 18–55 years; however the incidence rate varies between countries [[1], [2], [3], [4], [5]]. IS in young adults has socioeconomic consequences and leads to reduced long-term quality of life. Therefore, investigation of the risk factors and etiology of IS in young adults is important to prevent this disease and improve its prognosis.
Previous studies showed some potential risk factors and etiology; however, the study samples were heterogynous due to differences in the study methods across countries [2,3,6]. Therefore, the precise risk factors remain unknown. To the best of our knowledge, studies on IS in young adults in the Asian population has thus far been limited to single hospital-based and retrospective studies [7,8].
Therefore, the aim of the present study was to evaluate the risk factors, etiology, and outcomes of IS in young adults using a prospective multicenter study design.
Section snippets
Study sample
We performed a prospective multicenter study on the risk factors, etiology, and outcomes of IS in young adults in Japan. This study was organized by a central coordinating center in the Department of Neurology, the Jikei University School of Medicine and conducted at 37 centers in Japan. Patients were recruited from 37 clinical stroke centers across Japan from December 2015 to September 2018. The patient inclusion criteria were; 16–55 years of age and IS within 7 days from the onset of
Participants
We recruited 546 patients, of whom 27 did not provide consent to participate. Finally, we analyzed 519 patients, corresponding to a study population coverage of 95.1% (519/546).
We performed cervical echo in 414 patients (80%), MRA for extracranial vessels in 170 (33%), and DSA in 118 (23%). TTE was performed in 455 patients (88%) and TEE in 184 (35%).
Table 1, Table 2 show the baseline characteristics, clinical features, including the etiology subtype, and outcome of patients. The median age of
Discussion
This study was the first multicenter, prospective study for IS in Japanese young adults. Our study showed that the risk factors and etiology of IS in young adult were different across different sex and ages groups. Accurately, we demonstrated that risk factors associated with stroke tend to be significantly elevated in accordance with ages. In addition, we indicated that the most common major etiologies of stroke in young aged adults were SVD and IAD. Moreover, we found that approximately 10%
Conclusions
Our study revealed the risk factors, etiology, and outcome of IS in Japanese young adults. As with older patients, most patients in the young adult group have modifiable risk factors whose were more prevalent in men and increased with age. Although these resluts have already been found in Caucasian patient populations, we demonstrated for the first time that Japanese patients also had similar risk factor pattern. Additionally, we showed a new finding that IAD was the most common cause among the
Acknowledgments
The authors thank all centers and patients who have contributed to the study.
Contributor-ship statement
Yu Kono designed the study, undertook statistical analysis, and wrote the drafts of manuscript. Yasuyuki Iguchi and Kazumi Kimura contributed interpretation of the data and made critical revisions to the manuscript. Yoshitaka Murakami undertook statistical analysis.
All other authors involved in study governance and made critical revisions to the manuscript.
Funding
This study has been supported by an unrestricted scientific grant from Sanofi, Japan to the Jikei University School of Medicine.
Author disclosure
Yu Kono received research funding from Sanofi. The other authors report no conflict.
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