First-ever TIA or ischemic stroke in young adults was associated with long-term excess mortality (17.3% died over 9.2 years), with 74% of the absolute excess risk attributable to vascular causes.
Cohort (n=845)
No
Does a history of ischemic stroke or TIA increase long-term cause-specific mortality compared to the general population in young adults?
Long-term excess mortality after stroke or TIA in young adults is primarily driven by vascular causes, highlighting the need for long-term cardiovascular prevention.
Effect estimate: Absolute excess risk 2.8 per 1000 person-years for stroke (95% CI 1.8-4.1)
Adults with stroke at a young age (18-50 years) remain at an increased risk of death for decades. It is unclear what cause underlies this long-term excess mortality and whether this is sex and time specific. Therefore, we investigated sex-specific temporal changes in cause of death after transient ischemic attack or ischemic stroke in young adults aged 18 to 50 years. We included all 845 consecutive 30-day survivors, of a first-ever transient ischemic attack (n=261) or ischemic stroke (n=584), admitted to our hospital between 1980 and 2010. Survival status was assessed at April 1, 2013. Observed cause-specific mortality was compared with expected mortality, derived from mortality rates in the general population with similar age, sex, and calendar-year characteristics. During a median follow-up of 9.2 years, 146 patients (17.3%) died, such that 29 years of life was lost by each individual. For all causes of death, observed mortality exceeded expected mortality. The absolute excess risk of death was for 74% attributable to a vascular cause (absolute excess risk, 2.8 per 1000 person-years 95% confidence interval, 1.8-4.1 for stroke and absolute excess risk, 4.3 per 1000 person-years 95% confidence interval, 2.9-5.9 for other vascular causes). The absolute excess risk was highest between 10 and 15 years after stroke and this peak was most pronounced in men and mainly attributable to vascular death. Long-term excess death after stroke in young adults is mainly attributable to a vascular cause and most pronounced in men. Attempts to reduce the risk of vascular disease after stroke in young adults should extend beyond the acute phase into the long term.
Rutten‐Jacobs et al. (Tue,) conducted a cohort in Transient ischemic attack or ischemic stroke (n=845). Transient ischemic attack or ischemic stroke vs. General population (expected mortality) was evaluated on Cause-specific mortality (Absolute excess risk 2.8 per 1000 person-years for stroke, 95% CI 1.8-4.1). First-ever TIA or ischemic stroke in young adults was associated with long-term excess mortality (17.3% died over 9.2 years), with 74% of the absolute excess risk attributable to vascular causes.