Etiologic subtypes and risk factor profiles of first-ever cerebrovascular events in young adults: a retrospective study from a Chinese population

Objective Cerebrovascular events in young adults are clinically important, but their profile in China remains incompletely described. We aimed to describe stroke types, TOAST-based ischemic stroke subtypes, other determined etiologies, and risk-factor profiles in young Chinese adults with first-ever cerebrovascular events. Methods We retrospectively analyzed 795 consecutive adults aged 18–49 years admitted with first-ever cerebrovascular events in Shaanxi Province, China, from January 2017 to August 2019. Ischemic cerebrovascular events included ischemic stroke and transient ischemic attack; hemorrhagic stroke included intracerebral hemorrhage and non-traumatic subarachnoid hemorrhage. Ischemic stroke was classified using TOAST criteria. Two exploratory multivariable logistic regression models were fitted: the first compared ischemic cerebrovascular events with hemorrhagic stroke in the full cohort, and the second compared subarachnoid with intracerebral hemorrhage among patients with hemorrhagic stroke. Results Median age at onset was 45 years (IQR, 39–47), and 617 patients (77.6%) were men. Ischemic cerebrovascular events and hemorrhagic stroke accounted for 566 cases (71.2%) and 229 cases (28.8%), respectively. Among the 511 patients with ischemic stroke, the leading TOAST subtypes were large-artery atherosclerosis (149 [29.2%]), small-vessel occlusion or lacunar infarction (139 [27.2%]), followed by undetermined etiology (117 [22.9%]), cardioembolism (57 [11.2%]), and other determined etiology (49 [9.6%]). Arterial dissection (28 [57.1%]) and moyamoya disease or moyamoya syndrome (10 [20.5%]) predominated among other determined etiologies. Hypertension was more frequent in hemorrhagic stroke, whereas male sex, smoking, hyperhomocysteinemia, diabetes, and coronary artery disease were more frequent in ischemic cerebrovascular events. Conclusions In young Chinese adults with first-ever cerebrovascular events, men predominated. Ischemic cerebrovascular events predominated, but hemorrhagic stroke accounted for nearly one third of cases. Large-artery atherosclerosis and small-vessel occlusion were common TOAST subtypes. Exploratory analyses showed that risk-factor profiles differed across event phenotypes. These findings require validation in multicenter studies.