Abstract Background and aims Young strokes are increasing and understanding the risk factors relating to recurrence and other vascular events is essential. Methods Patients aged 18-49 years with first imaging positive ischemic stroke between 01/01/2013 and 31/12/2020 were included. Medical records were examined for demographics, risk factors, presentation, investigations and post stroke recurrence, cardiac events, peripheral vascular disease and venous thromboembolism. Median time to event(s) between groups were calculated using Kaplan-Meier analysis and compared using the log-rank test. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated from the multivariable Cox proportional hazards model to identify associated factors. Results 1424 ischemic stroke patients (60.6% male, median age 44 years) were analysed. 6.2% had a recurrent stroke, 2.6% a cardiac event, 2.1% peripheral vascular disease and 3.5% venous thromboembolism. Median time to event was 747, 1054, 1541 and 51 days respectively. Adjusted cox regression identified large artery atherosclerosis (HR 2.70, 95% CI 1.34-5.45) and diabetes (1.93, 1.15-3.22) were associated with recurrent stroke, and cardio-embolic stroke (4.51, 1.36-14.95), diabetes (2.25, 1.05-4.83) and family history of stroke (4.93, 1.07-22.67) were associated with post stroke cardiac event. Large artery atherosclerosis (1.90, 1.15-3.13) , diabetes (2.38, 1.67-3.41) previous antiplatelet use (2.91, 1.18-7.22), family history (2.61, 1.06-6.46) and recreational drug use (2.10, 1.30-3.38) were associated with a composite of these endpoints. Conclusions A significant proportion of young ischemic strokes have recurrent vascular events, with identifiable risk factors that should be a target for secondary prevention. Conflict of interest Phillip Ferdinand, nothing to disclose. Ram Bajpai, nothing to disclose. Holly Maguire, nothing to disclose. Mohammed Shoaib, nothing to disclose. Balamrit Sokhal, nothing to disclose. Shadman Ahmed, nothing to disclose. Josh Goraya, nothing to disclose. Christian Mallen, nothing to disclose. Christine Roffe, nothing to disclose.
Ferdinand et al. (2026) studied this question.