Higher long-term mortality risk seen after young-adult stroke

Young adults who have had a stroke are at higher risk of long-term mortality compared with expected mortality, according to report published March 20 in the Journal of the American Medical Association.

Researchers from The Netherlands investigated the long-term mortality and cause of death after an initial acute stroke in adults aged 18 to 50 years and compared this to mortality rates of age- and sex-matched adults who had not suffered a stroke.  The main outcome measure was cumulative 20-year mortality of 30-day survivors of stroke.

More than 900 patients with first-ever stroke or transient ischemic attack (TIA) were included in the FUTURE (The Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluations) study between January 1980 and November 2010. Approximately 27% (262) patients had a TIA, 63% (606) had an ischemic stroke, and 9.5% (91) had an intracerebral hemorrhage. The mean follow-up was 11.1 years (range, 2.0-17.4 years).

At the end of follow-up, 20% (192) of patients had died. The cumulative 20-year risk of mortality among 30-day survivors was highest among patients who had ischemic stroke (26.8%) versus 7.6% expected mortality, followed by 24.9% for patients with TIA versus 8.5% expected mortality (after the 10-year follow-up point), and 13.7% for intracerebral hemorrhage versus 5.6% expected mortality, the authors noted.

“We showed that even 20 years following stroke in adults aged 18 through 50 years, patients remain at a significantly higher risk of death compared with the general populations,” said Loes C.A. Rutten-Jacobs, MSc, and colleagues. “This mortality remained at this higher level even in the second and third decade after young stroke. In patients who survived the first 30 days after an ICH, mortality gradually coincided with that expected.”

Underlying vascular disease that caused the initial stroke at a young age puts these adults at increased risk of continued vascular disease. In addition, smoking and alcohol consumption also contribute to this risk

“Although data are lacking, the observation of long-term increased risk for vascular disease could have important implications of secondary prevention (both medical and lifestyle) treatment strategies,” the authors said.