Individuals between ages 18 and 50 who have a stroke may have a higher rate of mortality at 20 years than healthy controls, according to research published in the March 20 JAMA. Of 959 patients with a first-ever ischemic stroke, transient ischemic attack (TIA), or intracerebral hemorrhage, 192 died during follow-up.
Observed mortality after ischemic stroke was increased, compared with expected mortality in the general population, throughout the entire 20-year follow-up period (26.8% versus 7.6%, respectively). Observed mortality after TIA was increased, compared with expected mortality, for the first 10 years of follow-up (24.9% versus 8.5%, respectively). In patients who survived the first 30 days after an intracranial hemorrhage, the rate of mortality gradually became equal to the expected rate.
Loes C. A. Rutten-Jacobs, MSc, a doctoral candidate at Radboud University in Nijmegen, the Netherlands, and colleagues examined data for 959 consecutively enrolled participants in the Follow-Up of TIA and Stroke Patients and Unelucidated Risk Factor Evaluation study, a prospective study of prognosis after TIA, ischemic stroke, or hemorrhagic stroke in adults ages 18 to 50. Patients were enrolled at Radboud University Nijmegen Medical Center between 1980 and 2010. A total of 262 patients had TIA, 606 had ischemic stroke, and 91 had intracerebral hemorrhage.
The study results "suggest that the underlying (vascular) disease that caused the stroke at relatively young age continues to put these patients at an increased risk for vascular disease throughout their lives," said Ms. Rutten-Jacobs. "Although data are currently lacking, the observation of long-term increased risk for vascular disease could have important implications for the implementation of secondary prevention (both medical and lifestyle) treatment strategies. Future studies should address the role of this stringent implementation in these patients with young stroke," she concluded.
"The validity of the results reported by Rutten-Jacobs et al is supported by the rigorous study design and methods," said Graeme J. Hankey, MD, Clinical Professor of Neurology at the University of Western Australia in Perth, in an accompanying editorial. "The implications of these results for clinicians are that adults younger than 50 with stroke, particularly those with cardioembolic ischemic stroke and other traditional risk factors, need to be recognized as being at substantially higher risk of death over the next 10 to 20 years than their fellow community residents of the same age and sex who have not had a stroke," he concluded.
Rutten-Jacobs LC, Arntz RM, Maaijwee NA, et al. Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013;309(11):1136-1144.
Hankey GJ. Stroke in young adults. JAMA. 2013;309(11):1171-1172.