Stroke at Young Age Ups Risk for Death

Patients who experience stroke at age 50 years or younger had a significantly increased risk for mortality compared with the expected mortality in the general population, according to data from the Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, published in the Journal of the American Medical Association. In fact, depending on the type of event, stroke at an earlier age increased mortality at least 3-fold.

The study, conducted in the Netherlands, looked at 959 adults aged 18 to 50 years who experienced transient ischemic attack (TIA; n=262), ischemic stroke (n=606), or hemorrhagic stroke (n=91). During the mean 11-year follow-up period, 20% of patients died.

The researchers calculated the 20-year risk for death among stroke patients who survived 30 days or more. For TIA, the 20-year mortality risk was 24.9%; 29 patients had died, while only 11.2 deaths were expected, translating into a standardized mortality ratio (SMR) of 2.6 (P<.001).

These numbers only increased for ischemic and hemorrhagic stroke. Nine patients died of hemorrhagic stroke compared with 2.3 expected deaths (SMR=3.9; P<.001) and 111 died of ischemic stroke compared with 28.6 expected deaths (SMR=3.9; P<.001).

“To minimize the higher-than-expected mortality, the underlying cause of the stroke (eg, atherosclerosis, atrial fibrillation, valvular heart disease) and cause of the symptomatic cardiovascular disease (eg, hypertension, smoking, alcohol abuse) need to be diagnosed accurately at presentation, treated appropriately and, if possible, eliminated,” wrote editorialists commenting on the study. “If elimination of the cause is not possible, long-term follow-up and control of the disease and its risk factors need to be maintained vigilantly.”

Read the study abstract.

Read a preview of an accompanying editorial.