Risk Factors and Acute-Phase Blood Markers in Stroke Among Young Adults: A Hospital-Based Case-Control Study from South India

Background: Early-onset stroke carries profound health and socioeconomic consequences and is an escalating concern owing to increased cardiovascular risk in young adults. This study explores lifestyle and comorbid risk factors in predicting stroke occurrence among young Indian adults. We also analyze post-admission blood markers to reveal acute-phase metabolic and inflammatory dysregulation. Methods: Unicentric case-control study of 40 cases of imaging confirmed acute stroke and 81 sex-matched controls all aged ≤45. Self-reported demographic, lifestyle and comorbidity histories, and laboratory reports within 6–8 hours post-admission were collected. Conditional and multivariate logistic regression estimated stroke odds associated with risk factors. Age- and sex-stratified analyses explored clustering of risk and pathophysiological derangements among subgroups. Results: Hypertension (OR: 22.0, P < 0.001) and regular alcohol consumption (OR: 6.7, P = 0.047) independently conferred the strongest stroke odds. The youngest subgroup (18–30 years) carried 17-fold higher odds with alcohol use ( P = 0.024) and had elevated bilirubin ( P = 0.014). Elevated white blood cells, creatinine, post-prandial blood sugar, and hyponatremia were found among cases, with females exhibiting higher platelets ( P = 0.002) and depressed ALT ( P = 0.010), and males, elevated hemoglobin ( P = 0.027). Significant risk-factor clustering was found between hypertension and diabetes among male and female cases ( P = 0.027, P = 0.041) with complete concomitance of smoking and alcohol use in male cases and controls ( P = 0.031, P = 0.012). Conclusions: This study compellingly identifies hypertension and alcohol use as major, independent predictors of early-onset stroke, underscoring distinct pathogenesis in this cohort and the urgent need for early detection, aggressive management, and behavioral modification. Stratified analyses further unveiled novel insights on age- and sex-specific heterogeneity in risk profiles and pathophysiology.