Long-term risk of recurrent vascular events after young stroke: The FUTURE study

• Published in: Annals of neurology Vol. 74; no. 4; pp. 592 - 601
• Main Authors: Rutten-Jacobs, Loes C. A., Maaijwee, Noortje A. M., Arntz, Renate M., Schoonderwaldt, Henny C., Dorresteijn, Lucille D., van der Vlugt, Maureen J., van Dijk, Ewoud J., de Leeuw, Frank-Erik
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-10-2013; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Age Factors; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cerebral Hemorrhage - etiology; Cohort Studies; Confidence intervals; Drug therapy; Female; Heart attacks; Humans; Ischemic Attack, Transient - complications; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Stroke; Stroke - complications; Stroke - epidemiology; Young Adult
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.23953

Objective
Long‐term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long‐term risk of recurrent vascular events after young stroke.
Methods
We prospectively included 724 consecutive patients with a first‐ever transient ischemic attack (TIA), ischemic stroke, or intracerebral hemorrhage (ICH), aged 18 to 50 years, admitted to our hospital between January 1, 1980 and November 1, 2010. Outcomes were (1) stroke; (2) myocardial infarction or cardiac or peripheral arterial revascularization procedures; or (3) composite event of these, whichever occurred first.
Results
After a mean follow‐up of 9.1 years (standard deviation = 8.2, range = 0–31.0), 142 patients (19.6%) had at least 1 recurrent vascular event. Cumulative 20‐year risk of stroke was 17.3% (95% confidence interval [CI] = 9.5–25.1) after TIA, 19.4% (95% [CI] = 14.6–24.3) after ischemic stroke, and 9.8% (95% CI = 1.0–18.7) after ICH. Cumulative 20‐year risk of any vascular event was 27.7% (95% CI = 18.5–37.0) after TIA and 32.8% (95% CI = 26.7–38.9) after ischemic stroke. Age and male sex were associated with other arterial events, but not with stroke. Among TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes, adjusted for age, sex, and decennium of inclusion, atherothrombotic stroke, cardioembolic stroke, and lacunar stroke were associated with recurrent stroke (hazard ratio [HR] = 2.72, 95% CI = 1.34–5.52; HR = 2.49, 95% CI = 1.23–5.07; and HR = 2.92, 95% CI = 1.45–5.88, respectively).
Interpretation
Patients with young stroke remain at substantial risk of recurrent vascular events for decades, suggesting that the underlying disease that caused stroke at a young age continues to put these patients at a high risk for vascular disease throughout their lives. Ann Neurol 2013;74:592–601