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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 25  |  Issue : 2  |  Page : 66-69

Risk factors for familial and nonfamilial young ischemic stroke


Neurology Department, Pyongyang Medical College, Kim Il Sung University, Pyongyang, Democratic People’s Republic of Korea

Date of Submission27-Apr-2019
Date of Acceptance09-Dec-2019
Date of Web Publication04-Mar-2020

Correspondence Address:
Se Ryong Han
MSc, Pyongyang Medical College, Kim Il Sung University, Pyongyang, Democratic People’s Republic of Korea
Democratic People’s Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kamj.kamj_12_19

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  Abstract 


Aim In this study, the authors presented the 10-year survey on risk factors among young patients with ischemic stroke according to their family history.
Patients and methods The population includes 92 young patients with ischemic stroke who had been admitted at Neurology Department of Pyongyang Medical College Hospital, Kim Il Sung University, between January 2007 and August 2016. Among them, young patients with familial history of ischemic stroke were 34 (11 females and 23 males), with a mean age of 38.9±3.54 years, and nonfamilial ones were 58 (13 females and 45 males), with mean age of 37.5±4.21 years (18–44 years old).
Results Young patients with familial history of ischemic stroke with 5–10 risk factors were more than nonfamilial group, but young patients with nonfamilial ischemic stroke with 10–15 risk factors were more than familial group. Moreover, the effect of each risk factor is different in the two groups.
Conclusion Incidence of young ischemic stroke is different between familial and nonfamilial groups, and nonfamilial patients have more risk factors than familial ones.

Keywords: familial, risk factor, stroke, young


How to cite this article:
Sin H, Hwang SO, Jo SH, Song GS, Han SR. Risk factors for familial and nonfamilial young ischemic stroke. Kasr Al Ainy Med J 2019;25:66-9

How to cite this URL:
Sin H, Hwang SO, Jo SH, Song GS, Han SR. Risk factors for familial and nonfamilial young ischemic stroke. Kasr Al Ainy Med J [serial online] 2019 [cited 2020 May 29];25:66-9. Available from: http://www.kamj.eg.net/text.asp?2019/25/2/66/279973




  Introduction Top


The incidence of ischemic stroke increases with age, and the prevalence of stroke in young is very low. However, it causes socioeconomical disabilities in young adults.

Ischemic stroke is a multifactorial disease, and individuals with predisposition are quite vulnerable to risk factors. While emphasizing the importance of genetics, it was proven that there is a difference of incidence in familial and nonfamilial young ischemic stroke. ‘Stroke in young’ often has impression of genetic disease [1].


  Patients and methods Top


The study was designed on retrospective data. We had the approval of the ethics committee of Pyongyang Medical College, Kim Il Sung University. The population includes 92 young patients with ischemic stroke (<45 years old) who had been admitted at Neurology Department of Pyongyang Medical College Hospital, Kim Il Sung University, between January 2007 and August 2016.

We obtained data from database of the hospital. The patients were diagnosed with confirmed CT and MRI. Young patients with familial history of ischemic stroke comprised 34 (11 females and 23 males) with a mean age of 38.9±3.54 years and non-familial ones comprised 58 (13 females and 45 males), with a mean age of 37.5±4.21 years (18–44 years old).

We selected 100 relatively healthy young people (<45 years old) as a control group.

Sex distribution is shown in [Table 1].
Table 1 Sex distribution of ischemic stroke in young patients

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We identified the risk factors for young ischemic stroke among the selected patients [2],[3],[4],[5],[6],[7],[8].

The risk factors for ischemic stroke are 17 in all: nonmodifiable (sex and season), modifiable (smoke, coffee, snack, sedentary job, night shift, obesity, and alcohol abuse), and medical diseases [hypertension, atrial fibrillation, dyslipidemia, diabetes mellitus (DM), past history of transient ischemic attack (TIA), migraine, sleep apnea syndrome (SAS), and dental caries] [2],[3],[4],[5],[6],[7],[8],[9].

P value and confidence interval values were considered to demonstrate significantly different rates.

Statistical analysis

All data were analyzed with SPSS 18.0 (IBM, New York, USA).


  Results Top


The study included 92 young patients with ischemic stroke (<45 years old) and 100 relatively healthy young adults (<45 years old).

Among young patients with ischemic stroke, there are 34 patients with family history of ischemic stroke and 58 patients without family history, and there are 50 individuals each in the healthy group ([Table 1]).

We identified 17 risk factors for ischemic stroke in 92 young patients with ischemic stroke. For convenience, the risk factors are divided into three groups: nonmodifiable (sex and season), modifiable (smoke, coffee, snack, sedentary job, night shift, obesity, and alcohol abuse), and medical diseases (hypertension, atrial fibrillation, dyslipidemia, DM, past history of TIA, migraine, SAS, and dental caries). The risk factors are shown in [Table 2].
Table 2 Risk factors for ischemic stroke in young patients

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Each young patient with ischemic stroke has a different number of ischemic stroke that we identified. Moreover, on an average, young patients with non-familial ischemic stroke have more risk factors than young patients with familial ischemic stroke. The distribution of risk factors in familial and nonfamilial group is shown in [Table 3].
Table 3 Distribution of risk factors in familial and non-familial young ischemic stroke groups

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Young patients with familial ischemic stroke with 5–10 risk factors were significantly more than nonfamilial group (P<0.05), but young patients with nonfamilial ischemic stroke with 10–15 risk factors were significantly more than the familial group (P<0.05).

This result shows the young patients with ischemic stroke having a family history are likely to have less risk factors.

In familial and nonfamilial groups, we analyzed the effect of risk factors respectively according to odds ratio (OR), and we found some differences in the effect of risk factors for two groups.

All the risk factors that we identified were significant ones (P<0.05).

The order of risk factors in familial group is shown in [Table 4] according to OR. The strongest risk factor was past history of TIA (OR=4.49, 95% confidence interval=1.12–6.54, P<0.01) and the rest comprised hypertension, obesity, smoking, alcohol abuse, dental caries, sex, atrial fibrillation, dyslipidemia, snack, DM, coffee, season, sedentary job, migraine, and night shift.
Table 4 Risk factors in familial young ischemic stroke group

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Moreover, the order of risk factors in nonfamilial group is shown in [Table 5] according to OR. The strongest risk factor was also history of TIA (OR=3.32, 95% confidence interval =1.08–5.32, P<0.01), and the rest comprised sex, obesity, smoking, DM, dyslipidemia, alcohol, hypertension, atrial fibrillation, night shift, coffee, snack, dental caries, SAS, migraine, sedentary job, and season.
Table 5 Risk factors in nonfamilial young ischemic stroke group

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We found variation in the OR for ischemic stroke risk factors in the two groups of young patients with ischemic stroke.


  Discussion Top


By using the available data registered in our hospital, we tried to evaluate risk factors involved in young patients with familial and nonfamilial ischemic stroke.

The incidence of ischemic stroke among young individuals is very low: 2.4/100 000 in 20–24 years old, 2.5/100 000 in 30–34 years old, and 32.9/100 000 in 45–49 years old [3].

Some researchers suggested that the risk factors for ischemic stroke included atrial fibrillation, dyslipidemia, smoking, meal, and physical activity [1],[2],[3],[9],[10] and in the young group, male patients were more than female patients [3],[9].

Alcohol abuse is another risk factor for not only ischemic stroke but also hemorrhagic stroke and migraine, which increase the risk of ischemic stroke almost threefolds [3].

Another researcher found the fact that hypertension, smoking, dyslipidemia, heart disease, metal stress, and DM type-2 were common risk factors for ischemic stroke, and importantly more than 50% of individuals who had past history of TIA would appear with ischemic stroke [4],[6],[7].Season is another risk factor for stroke; in particular, the incidence of ischemic stroke was higher in winter than in other season [7].

Stroke is a heterogeneous multifactorial disease. Studies conducted in twins, families, and animal models provide evidence for a genetic contribution to stroke, although the real effect of genetics is still unknown [5].

Through our research, we can know that there are more risk factors in the nonfamilial young ischemic stroke group than the familial group.

Moreover, the effect of each risk factor is different in both group, so if we take an appropriate measure according to the family history, it would be helpful in the prevention of ischemic stroke.

It is just a first step for us to study genetic association with ischemic stroke.


  Conclusion Top


The incidence of ischemic stroke in young is different with family history. Young patients with ischemic stroke with a family history have less risk factors than without family history, and the effect of each risk factor is different between familial and nonfamilial groups.

Acknowledgements

Concepts was done by Sin Chol Ho and Sin O. Hwang; design was done by Sin Chol Ho; definition of intellectual content done by Sin Chol Ho, Sin O. Hwang, and Jo Sun Hwa; literature search done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; clinical studies was done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; experimental studies was done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; data acquisition done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; data analysis was done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; statistical analysis was done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; manuscript preparation was done by Sin Chol Ho, and Han Se Ryong; manuscript editing done by Han Se Ryong; manuscript review was done by Sin Chol Ho, Sin O. Hwang, Jo Sun Hwa, Song Gum Song, and Han Se Ryong; and the guarantor is Sin Chol Ho.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Francis J, Raghunathan S, Khanna P. The role of genetics in stroke. Postgrad Med J 2007; 83:590–595.  Back to cited text no. 1
    
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Đelilović-Vranić J, Alajbegović A, Tirić-Čampara M, Todorović L. Stroke at a younger age. J Original Sci Paper Acta Clin Croat 2011; 50:185–191.  Back to cited text no. 4
    
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Stoll M, Ruhle F, Nowak-Gottl U. Advances in understanding stroke risk in children − a geneticist’s view. Br J Haematol 2014; 164:636–645.  Back to cited text no. 5
    
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Peters SAE, Huxley RR, Woodward M. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes. Lancet 2014; 383:1973–1980.  Back to cited text no. 6
    
7.
Vanja BA, Zanoreo KI, Demari V. Etiology and diagnostic work-up in young stroke patients. Periodicum Biologorum 2012; 114:355–359.  Back to cited text no. 7
    
8.
Yao X-Y, Lin Y, Geng J-L, Sun Y-M, Chen Y, Shi G-W et al. Age- and gender-specific prevalence of risk factors in patients with first-ever ischemic stroke in China. Stroke Res Treatment 2012; 136398:1–6.  Back to cited text no. 8
    
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Fonseca AC, Ferro JM. Cryptogenic stroke. Eur J Neurol 2015; 22:618–623.  Back to cited text no. 9
    
10.
Worthmann H, Schwartz A, Heidenreich F, Sindern E, Lorenz R. Educational campaign on stroke in an urban population in Northern Germany: influence on public stroke awareness and knowledge. Int J Stroke 2013; 8:286–292.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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