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Trends in risk of recurrence after the first ischemic stroke in adults younger than 55 years of age in Sweden

Journal article
Authors Kok Wai Giang
Lena Björck
Christina Hedén Ståhl
Susanne Nielsen
Tatiana Zverkova Sandström
Christina Jern
Kjell Torén
Annika Rosengren
Published in International Journal of Stroke
Volume 11
Issue 1
Pages 52-61
ISSN 1747-4930
Publication year 2016
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Health and Care Sciences
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 52-61
Language en
Keywords Epidemiology, stroke, younger age, ischemic stroke, recurrent stroke, temporal trend, long-term risk, vascular events, unit care, health, association, predictors, prevention, infarction, mortality, register, Cardiovascular System & Cardiology
Subject categories Cardiovascular medicine, Epidemiology


Background: Previous studies on stroke recurrence in younger adults often contain small sample size which makes it difficult to study trends in stroke recurrence over a long period of time. Aims: The aim of the present study was to investigate temporal trends in the risk of recurrence in younger patients with a first ischemic stroke. Methods: All men and women aged 18-54 years who had survived at least 28 days after a first ischemic stroke from 1987 to 2006 were identified in the Swedish Inpatient Register. The patients were stratified into four 5-year periods according to their admission period and were followed up for a total of four years after the index event with regard to recurrent ischemic stroke. A Cox regression model was used to analyze the risk of recurrent ischemic stroke. Results: Of the 17,149 ischemic stroke patients who were identified, 2432 (14.2%) had a recurrent ischemic stroke event within four years. From the first to the last periods (1987-1991 versus 2002-2006), the four-year risk of recurrent ischemic stroke decreased by 55% (hazard ratio 0.45, 95% confidence interval 0.39-0.53) in men and 59% (hazard ratio 0.41, 95% confidence interval, 0.33-0.50) in women. The cumulative four-year risk was 11.8% (95% CI 10.55-13.25) in men and 9.8% (95% CI 8.40-11.46) in women during the last five-year period (2002-2006). Conclusions: The risk of recurrence among younger ischemic stroke patients has decreased over the past 20 years. Despite these improvements, younger patients are still at a high risk for recurrent ischemic stroke.

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