Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 cities young stroke study.
OBJECTIVE
We compared among young patients with ischemic stroke the distribution of vascular risk factors among sex, age groups, and 3 distinct geographic regions in Europe.


METHODS
We included patients with first-ever ischemic stroke aged 15 to 49 years from existing hospital- or population-based prospective or consecutive young stroke registries involving 15 cities in 12 countries. Geographic regions were defined as northern (Finland, Norway), central (Austria, Belgium, France, Germany, Hungary, The Netherlands, Switzerland), and southern (Greece, Italy, Turkey) Europe. Hierarchical regression models were used for comparisons.


RESULTS
In the study cohort (n=3944), the 3 most frequent risk factors were current smoking (48.7%), dyslipidemia (45.8%), and hypertension (35.9%). Compared with central (n=1868; median age, 43 years) and northern (n=1330; median age, 44 years) European patients, southern Europeans (n=746; median age, 41 years) were younger. No sex difference emerged between the regions, male:female ratio being 0.7 in those aged <34 years and reaching 1.7 in those aged 45 to 49 years. After accounting for confounders, no risk-factor differences emerged at the region level. Compared with females, males were older and they more frequently had dyslipidemia or coronary heart disease, or were smokers, irrespective of region. In both sexes, prevalence of family history of stroke, dyslipidemia, smoking, hypertension, diabetes mellitus, coronary heart disease, peripheral arterial disease, and atrial fibrillation positively correlated with age across all regions.


CONCLUSIONS
Primary preventive strategies for ischemic stroke in young adults-having high rate of modifiable risk factors-should be targeted according to sex and age at continental level.
Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290, Helsinki, Finland. jukka.putaala@hus.fi
Jukka
J
Putaala
Nilufer
N
Yesilot
Ulrike
U
Waje-Andreassen
Janne
J
Pitkäniemi
Sofia
S
Vassilopoulou
Katiuscia
K
Nardi
Celine
C
Odier
Gergely
G
Hofgart
Stefan
S
Engelter
Annika
A
Burow
Laszlo
L
Mihalka
Manja
M
Kloss
Julia
J
Ferrari
Robin
R
Lemmens
Oguzhan
O
Coban
Elena
E
Haapaniemi
Noortje
N
Maaijwee
Loes
L
Rutten-Jacobs
Anna
A
Bersano
Carlo
C
Cereda
Pierluigi
P
Baron
Linda
L
Borellini
Caterina
C
Valcarenghi
Lars
L
Thomassen
Armin J
AJ
Grau
Frederick
F
Palm
Christian
C
Urbanek
Rezzan
R
Tuncay
Aysan
A
Durukan-Tolvanen
Ewoud J
EJ
van Dijk
Frank-Erik
FE
de Leeuw
Vincent
V
Thijs
Stefan
S
Greisenegger
Konstantinos
K
Vemmos
Christoph
C
Lichy
Daniel
D
Bereczki
Laszlo
L
Csiba
Patrik
P
Michel
Didier
D
Leys
Konstantinos
K
Spengos
Halvor
H
Naess
Sara Zarko
SZ
Bahar
Turgut
T
Tatlisumak
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003710:Demography; D050171:Dyslipidemias / Q000150:complications*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology*; D013997:Time Factors; D055815:Young Adult