title: Cardiovascular disease is the main cause of long-term excess mortality after ischemic stroke in young adults.
abstract: 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.
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.).
authors.forename: Loes C A
authors.initials: LC
authors.lastname: Rutten-Jacobs
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.).
authors.forename: Renate M
authors.initials: RM
authors.lastname: Arntz
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.).
authors.forename: Noortje A M
authors.initials: NA
authors.lastname: Maaijwee
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.).
authors.forename: Hennie C
authors.initials: HC
authors.lastname: Schoonderwaldt
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.).
authors.forename: Lucille D
authors.initials: LD
authors.lastname: Dorresteijn
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.).
authors.forename: Ewoud J
authors.initials: EJ
authors.lastname: van Dijk
authors.affiliation: From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.). FrankErik.deLeeuw@radboudumc.nl.
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000401:mortality*; D015996:Survival Rate; D055815:Young Adult
keywords: cardiovascular diseases; cause of death; longitudinal studies; mortality; stroke