Analysis of young ischemic stroke patients in northeast China

Background: Limited research has been conducted to address stroke etiology in young patients in developing countries. We aimed to analyze risk factors and etiology of ischemic stroke (IS) in young patients of northeast China. Methods: We retrospectively analyzed ischemic stroke patients aged 15-49 years in a single-center study from January 2013 to December 2017. Demographics and clinical information, including imaging studies, were retrieved for all patients. Patients were first compared according to sex and age. They were then divided into the first-ever and recurrent stroke groups; risk factors and stroke etiology between the two groups were compared. Results: Of the 956 patients (median age 45 years) included, 78.9% were males. The most frequent risk factors were hypertension (60.0%), dyslipidemia (55.3%), smoking (54.1%), and alcohol consumption (49.6%). The most common etiology of stroke was large-artery atherosclerosis (LAA, 43.7%). In total, 789 patients experienced first-ever stroke and 167 patients experienced recurrent stroke. Recurrent stroke patients more often suffered from hypertension (70.7% versus 57.8%, P=0.002), diabetes (35.3% versus 24.8%, P=0.005), and coronary heart disease (10.2% versus 5.1%, P=0.011), and were less likely to be smokers (44.3% versus 56.1%, P=0.005) and consume alcohol (38.3% versus 52.0%, P=0.001). Recurrent strokes were more frequently caused by LAA (42.1% versus 52.5%, P=0.026) and less often by small-vessel disease (40.9% versus 29.9%, P=0.008). Conclusions: LAA is the mast common etiology in Chinese young stroke patients, especially in those with recurrent stroke. Our data highlight the need of screening of LAA and prevention and management of conventional stroke risk factors in young people of China.