Neurologisk JC

Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke

Background

• Stroke is a leading cause of death and disability
  
• Traditionally considered a disease of older adults
  
• Rising stroke incidence among young adults (18–55 years old)
  
• Increasing vascular risk factors (VRFs) may be driving this trend
  
• Study aims to analyze temporal trends in VRF burden among young stroke patients

Study Design & Data Source

• Prospective Cohort Study using Florida Stroke Registry (FSR)
  
• Data collected from 2014–2022 across 172 hospitals
  
• Inclusion Criteria:
  • Patients 18–55 years old with ischemic stroke (IS)
    
• Exclusion Criteria:
  • Patients outside age range
    
  • Patients with TIA, intracranial hemorrhage, or subarachnoid hemorrhage

Data Collection & Variables

• Data obtained from Get With The Guidelines-Stroke (GWTG-S)
  
• Demographics:
  • Age, sex, race/ethnicity
    
• Vascular Risk Factors (VRFs):
  • Hypertension, dyslipidemia, obesity, diabetes, smoking
    
  • Atrial fibrillation, coronary artery disease, heart failure, sleep apnea
    
• Polymorbidity: Defined as 3 or more VRFs

Statistical Analysis

• Comparative Analysis:
  • Continuous variables: t-test / Wilcoxon-Mann-Whitney
    
  • Categorical variables: Chi-square test
    
• Temporal Trends Analysis:
  • VRF trends assessed across study period

Main Results

• Total patients analyzed: 36,488
  
• Age breakdown:
  • 18–35 years: 3,363 patients (9.2%)
    
  • 36–55 years: 33,125 patients (90.8%)

• Key Findings:
  • Polymorbidity (≥3 VRFs) increased over time:
    • 18–35 years: 10.9% → 16.4% (p = 0.002)
      
    • 36–55 years: 34.6% → 41.9% (p < 0.001)
      
  • Higher VRF burden in:
    • Non-Hispanic Black patients
    • Male patients
      
  • Most common VRFs: Hypertension, obesity, diabetes

Strengths of the Study

✅ Large, diverse cohort from a statewide registry
✅ Standardized data collection via GWTG-S
✅ Analyzed temporal trends in VRFs
✅ Examined racial & sex disparities in VRF burden

Study Limitations

❌ Limited generalizability (Florida hospitals only)
❌ No stroke etiology data (high missingness)
❌ Unknown VRF severity & management (no treatment data)
❌ Potential bias in VRF reporting (better diagnosis over time)
❌ Lack of socioeconomic data (income, education, access to care)

Conclusion

• VRF burden is increasing in young adults with stroke
  
• Disparities exist—higher polymorbidity in Black and male patients
  
• Early identification & prevention strategies are crucial
  
• Future research should focus on stroke etiology & socioeconomic factors