Ischemic stroke in young adults: risk factors

Abstract

Background. Epidemiological evidence suggests that the prevalence of ischemic stroke in young adults (18-50 years) has increased significantly. This is partly attributed to a rise in the incidence of standard risk factors such as hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. Additionally, there are non-modifiable risk factors including migraine, pregnancy and postnatal period, illicit drug use, oral contraceptives and hypercoagulable state. Over 150 identified causes of early-onset ischemic stroke exist, including rare monogenic disorders. Although the chances of surviving stroke at a young age are distinctly better than for those at an older age, young survivors face an increased risk of recurrent strokes and other adverse events, such as neuropsychological problems and seizures for a much longer time span. Aim. The aim of the study is to review the scientific literature and summarize information about the risk factors of early onset ischemic stroke. Methods. A PubMed search was conducted according to PRISMA guidelines. Using keywords and their combinations the most relevant articles in English language were selected. The majority of the analysed publications were published over the last 10 years. Out of 392 scientific publications collected with keywords and filters, 57 potentially relevant studies were left after the elimination of duplicates and a brief analysis of titles and abstracts. Full texts were further screened for final inclusion and 35 studies were included in this systematic literature review. Conclusions. While early onset stroke is less common, the pathogenesis of stroke in younger adults requires consideration of some less common risk factors. An assiduous workup including testing for drug use, hypercoagulable causes, vascular imaging, and echocardiography can often identify or narrow down a list of possible pathogeneses, which is critical for prevention of recurrent strokes in younger adults. Systematic identification of risk factors and causes, as well as motivating patients for long-term prevention and lifestyle changes, is of utmost significance in improving prognosis of early-onset ischemic stroke. More research is needed to find novel risk factors and causes explaining the large proportion of cryptogenic strokes and better understand the factors influencing long-term prognosis to enhance management.