title: Cardiovascular events after ischemic stroke in young adults: A prospective follow-up study.
abstract: To study the long-term risk of recurrent cardiac, arterial, and venous events in young stroke patients, and whether these risks differed between etiologic subgroups.
  
  
  
  The study population comprised 970 patients aged 15-49 years from the Helsinki Young Stroke Registry (HYSR) who had an ischemic stroke in 1994-2007. We obtained follow-up data until 2012 from the Finnish Care Register and Statistics Finland. Cumulative 15-year risks were analyzed with life tables, whereas relative risks and corresponding confidence intervals (CI) were based on hazard ratios (HR) from Cox regression analyses.
  
  
  
  There were 283 (29.2%) patients with a cardiovascular event during the median follow-up of 10.1 years (range 0.1-18.0). Cumulative 15-year risk for venous events was 3.9%. Cumulative 15-year incidence rate for composite vascular events was 34.0 (95% CI 30.1-38.2) per 1,000 person-years. When adjusted for age and sex, patients with an index stroke caused by high-risk sources of cardioembolism had the highest HR for any subsequent cardiovascular events (3.7; 95% CI 2.6-5.4), whereas the large-artery atherosclerosis group had the highest HR (2.7; 95% CI 1.6-4.6) for recurrent stroke compared with patients with stroke of undetermined etiology.
  
  
  
  The risk for future cardiovascular events after ischemic stroke in young adults remains high for years after the index stroke, in particular when the index stroke is caused by high-risk sources of cardioembolism or large-artery atherosclerosis.
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden. karoliina.aarnio@helsinki.fi.
authors.forename: Karoliina
authors.initials: K
authors.lastname: Aarnio
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Bob
authors.initials: B
authors.lastname: Siegerink
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jani
authors.initials: J
authors.lastname: Pirinen
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Juha
authors.initials: J
authors.lastname: Sinisalo
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Lehto
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Elena
authors.initials: E
authors.lastname: Haapaniemi
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Alexander-Heinrich
authors.initials: AH
authors.lastname: Nave
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.affiliation: From Clinical Neurosciences (K.A., E.H., M.K., T.T., J. Putaala), Neurology, University of Helsinki; Department of Neurology (K.A., E.H., M.K., T.T., J. Putaala), Helsinki University Central Hospital, Finland; Center for Stroke Research Berlin (CSB) (B.S., A.-H.N.), Charité Universitätsmedizin Berlin, Germany; Department of Cardiology (J. Pirinen, J.S., M.L.), Heart and Lung Center, Helsinki University Hospital, Finland; Institute of Neurosciences and Physiology (T.T.), Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012306:Risk; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult