Risk factor burden predicts long-term mortality in young patients with arterial cerebral infarction

Objective The aim was to investigate risk factors separately and in sum in relation to long-term mortality after arterial cerebral infarction in young adults. Materials and methods Mortality in relation to the number of risk factors (smoking, hypertension, hypercholesterolemia, diabetes mellitus, myocardial infarction, angina pectoris, and intermittent claudication known at the time of the index stroke) and etiology was studied in a population of young adults with first-ever arterial ischemic stroke at an age < 50 years. Cox regression analyses were performed. Results After a mean follow-up time of 18 years (the longest follow-up study after cerebral infarction in young adults), 12.5% with no risk factor had died while the corresponding frequencies in patients with 13 or more risk factors were 18.5%, 25.4%, and 53.1%, respectively (P < 0.001). The number of risk factors was associated with mortality on Cox regression analysis [hazard ratio (HR) = 1.6, P = 0.001]. A separate Cox regression analysis showed mortality to be associated with diabetes mellitus (HR = 3.0, P = 0.001), myocardial infarction (HR = 3.1, P = 0.001), and alcoholism (HR = 6.3, P < 0.001). Conclusion Increasing number of traditional risk factors is associated with long-term mortality in young adults with cerebral infarction indicating aggressive long-term secondary preventive treatment in selected patients.