Premature atherosclerosis

Atherosclerosis is an age-dependent process. The prevalence of large-artery atherosclerosis in case series of ischemic stroke in young adults has been substantially less than in older adults.1–4 Historically, data on the role of atherosclerosis in early-onset stroke have been limited for a variety of reasons. First, multi-institutional studies often have inconsistent evaluations of the cerebral vasculature, particularly the intracranial circulation. Second, studies may not report evidence for proximal atherosclerosis less severe than necessary to meet criteria for etiology. Emerging data, however, show a high incidence of modifiable atherosclerosis risk factors such as dyslipidemia, hypertension, diabetes mellitus, and smoking in young adults with ischemic stroke, and worse prognosis and outcomes due to these factors and underlying large-artery atherosclerosis.3–10 A better understanding of the extent of the role of atherosclerosis in ischemic stroke risk in young adults is important for preventive therapy recommendations.