At what age do risk factors begin to be associated with stroke?

At what age do risk factors begin to be associated with stroke?

In a case-control study, the presence of atherosclerotic risk factors in children was rare, and apparently not associated with the pathogenesis of arterial ischemic stroke in childhood or early adulthood.

But by the fourth and fifth decades of life, the presence of these risk factors was strongly associated with a significant risk of stroke – multiplied by almost 10 times.



Dr. Sharon N. Poisson

“Although strokes in childhood and early adulthood are not likely to be caused by atherosclerotic risk factors, these factors appear to increase over the course of early adulthood, coming to represent a significant stroke risk in the 30s and 40s. old,” he explained to Medscape the study’s first author, Dr. Sharon N. Poisson, MD and associate professor of neurology at University of Colorado, in the United States.

The findings were published online on August 1st in the journal JAMA Neurology.

In this study, the researchers focused on arterial ischemic stroke, not hemorrhagic stroke. “We know that hypertension, diabetes, smoking and obesity are risk factors for ischemic stroke, but what we didn’t know was the age at which these atherosclerotic risk factors actually start causing strokes,” said Dr. Sharon.

To find out more, Dr. Sharon and her team did a case-control study of data from the system Kaiser Permanente Northern California, which has been accumulating relevant data for 14 years (from January 1, 2000 to December 31, 2014).

The analysis included 141 children and 455 young adults with arterial ischemic stroke and 1382 age-matched controls.

The children were divided into two age groups: from 29 days old to 9 years old and from 10 to 19 years old.

In the younger group, there were 69 cases of arterial ischemic stroke. In the most advanced age group, there were 72 cases.

Young adults were divided into three age groups: 20 to 29 years old (n = 71 cases), 30 to 39 years old (144 cases) and 40 to 49 years old (240 cases).

Among pediatric controls, 168 children aged 29 days to 9 years (46.5%) and 196 children aged 10 to 19 years (53.8%) had arterial ischemic stroke.

There were 121 cases of ischemic stroke among controls aged 20 to 29 years, 298 cases among controls aged 30 to 39 years, and 599 cases in the age group 40 to 49 years.

In childhood, both cases and controls had a low prevalence of documented diagnoses of atherosclerotic risk factors. The odds ratio (OR) of having any atherosclerotic risk factor in arterial ischemic stroke was 1.87 for patients aged 0 to 9 years and 1.00 for patients aged 10 to 19 years.

But cases have increased over the years. The OR was 2.3 for patients aged 20 to 29 years, 3.57 for patients aged 30 to 39 years and 4.91 for patients aged 40 to 49 years.

The analysis also showed that the CR associated with multiple atherosclerotic risk factors was 5.29 for the 0-9 age group, 2.75 for the 10-19 age group, 7.33 for the 10-19 age group, 20 to 29 years, 9.86 for the age group 30 to 39 years and 9.35 for the age group 40 to 49 years.

The presence of multiple risk factors was rare in children, but became more prevalent with each decade of life.

The presumed cause of arterial ischemic stroke was atherosclerosis. There was evidence of atherosclerosis in 1.4% of cases aged 10 to 19 years, 8.5% aged 20 to 29 years, 21.5% aged 30 to 39 years and 42.5% aged 40 to 49 years.

“This study shows us that starting to accumulate these risk factors early in life clearly increases stroke risk at age 30 and 40, although stroke in adolescence and early adulthood may not be caused by risk factors. atherosclerotic. I hope we can spread that message, because the sooner we treat risk factors, the better the outcomes,” said Dr. Sharon.

Prevention starts in childhood

Cardiovascular disease prevention starts in childhood, which is a paradigm shift from how cardiovascular disease was thought a few decades ago, noted pediatric cardiologist Dr. Guilherme Baptista de Faia, from the Ann & Robert H. Lurie Children’s Hospital, in the United States.



Dr. Guilherme Baptista de Faia

“Our guidelines for risk factor reduction in children aim to address how or when we screen for these risk factors, how or when we intervene, and whether these interventions affect cardiovascular outcomes in the future. This article is part of growing research aimed at understanding the relationship between childhood cardiovascular risk factors and early cardiovascular disease,” said Dr. William.

“There has been an interesting progression in our understanding of the impact of cardiovascular risk factors in early life. Large cohorts such as Bogalusa Heart Study, Risk in Young Finns Study, Muscatine Study, Childhood Determinants of Adult Health, CARDIA and International Childhood Cardiovascular Cohorts (i3C), were fundamental to assess this issue”, he highlighted.

Knowing that the presence of atherosclerotic risk factors in childhood can lead to acceleration of atherosclerosis in adulthood opens the door to preventive medicine, said Dr. Guilherme, who did not participate in the study.

“This is where preventive medicine comes in. If we can identify the children most at risk, can we intervene to improve outcomes in the future?” he asked. Familial hypercholesterolemia is “a great example of this,” he added. “We can screen children early in life, there is an effective treatment, and we know from population studies that early treatment significantly lowers the risk of cardiovascular disease later in life.”

Dr. Sharon said she received funding from the US National Institutes of Health (NIH) while conducting this study, which was supported by the institute.

JAMA Neurol. Published online on August 1, 2022. Abstract

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