Long-term risk of recurrent vascular events after young stroke: The FUTURE study
Article first published online: 3 JUL 2013
© 2013 American Neurological Association
Annals of Neurology
Volume 74, Issue 4, pages 592–601, October 2013
How to Cite
Rutten-Jacobs, L. C. A., Maaijwee, N. A. M., Arntz, R. M., Schoonderwaldt, H. C., Dorresteijn, L. D., van der Vlugt, M. J., van Dijk, E. J. and de Leeuw, F.-E. (2013), Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Ann Neurol., 74: 592–601. doi: 10.1002/ana.23953
- Issue published online: 26 NOV 2013
- Article first published online: 3 JUL 2013
- Accepted manuscript online: 17 JUN 2013 06:58AM EST
- Manuscript Accepted: 18 MAY 2013
- Manuscript Revised: 7 MAY 2013
- Manuscript Received: 18 MAR 2013
Long-term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long-term risk of recurrent vascular events after young stroke.
We prospectively included 724 consecutive patients with a first-ever transient ischemic attack (TIA), ischemic stroke, or intracerebral hemorrhage (ICH), aged 18 to 50 years, admitted to our hospital between January 1, 1980 and November 1, 2010. Outcomes were (1) stroke; (2) myocardial infarction or cardiac or peripheral arterial revascularization procedures; or (3) composite event of these, whichever occurred first.
After a mean follow-up of 9.1 years (standard deviation = 8.2, range = 0–31.0), 142 patients (19.6%) had at least 1 recurrent vascular event. Cumulative 20-year risk of stroke was 17.3% (95% confidence interval [CI] = 9.5–25.1) after TIA, 19.4% (95% [CI] = 14.6–24.3) after ischemic stroke, and 9.8% (95% CI = 1.0–18.7) after ICH. Cumulative 20-year risk of any vascular event was 27.7% (95% CI = 18.5–37.0) after TIA and 32.8% (95% CI = 26.7–38.9) after ischemic stroke. Age and male sex were associated with other arterial events, but not with stroke. Among TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes, adjusted for age, sex, and decennium of inclusion, atherothrombotic stroke, cardioembolic stroke, and lacunar stroke were associated with recurrent stroke (hazard ratio [HR] = 2.72, 95% CI = 1.34–5.52; HR = 2.49, 95% CI = 1.23–5.07; and HR = 2.92, 95% CI = 1.45–5.88, respectively).
Patients with young stroke remain at substantial risk of recurrent vascular events for decades, suggesting that the underlying disease that caused stroke at a young age continues to put these patients at a high risk for vascular disease throughout their lives. Ann Neurol 2013;74:592–601