Stroke

Study examines risk factors for young-onset cryptogenic ischemic stroke

April 24, 2025

Study details: This study examined the burden and associations of modifiable risk factors in young-onset cryptogenic ischemic stroke (CIS) patients, stratified by the presence of high-risk patent foramen ovale (PFO). The study included 523 patients aged 18 to 49 years with recent CIS and 523 stroke-free controls, matched by age and sex, from 19 European sites.

Results: In patients with CIS without PFO, each additional traditional risk factor, such as hypertension, smoking, abdominal obesity, and high cholesterol (odds ratio [OR], 1.417); nontraditional risk factor, including migraine with aura, venous thrombosis, cancer, and chronic multisystem disorders (OR, 1.702); and female sex-specific risk factor, such as gestational diabetes, pregnancy complications, and estrogen use (OR, 1.700), significantly increased the risk of CIS. In patients with CIS with PFO, traditional risk factors (OR, 1.185) and nontraditional risk factors (OR, 2.656) were significant. Population-attributable risks for CIS without PFO were 64.7% for traditional, 26.5% for nontraditional, and 18.9% for female sex-specific risk factors. For CIS with PFO, these risks were 33.8%, 49.4%, and 21.8%, respectively. Migraine with aura was a significant contributor, with population-attributable risks of 45.8% for CIS with PFO and 22.7% for CIS without PFO.

Clinical impact: Addressing modifiable risk factors in young-onset CIS patients is important, particularly those with high-risk PFO. Traditional risk factors are crucial in CIS without PFO, while nontraditional factors are more critical in CIS with PFO. Migraine with aura, especially in women, plays a significant role in the development of young-onset CIS, suggesting targeted prevention strategies could be beneficial.

Source:

Putaala J, SECRETO Study Group, et al. (2025, April 17). Stroke. Burden of Modifiable Risk Factors in Young-Onset Cryptogenic Ischemic Stroke by High-Risk Patent Foramen Ovale. https://pubmed.ncbi.nlm.nih.gov/40242852/