Stroke in 50s Triples Future Death Risk

A Netherlands team reaffirms the importance of secondary prevention after stroke in young adults as a long-term and lifelong endeavor.  Frank-Erik de Leeuw, from the Radboud University Nijmegen Medical Centre (The Netherlands), and colleagues assessed long-term outcomes in the prospective Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study, which included 959 consecutive patients, ages 18 through 50 years, admitted to a single academic medical center for a first-ever transient ischemic attack (TIA, 262), ischemic stroke (606), or intracerebral hemorrhage (91) from 1980 through late 2010.  In the first 30 days after the event, the fatality rate was 0.4% for TIA, 3.6% for ischemic stroke, and 22% for hemorrhagic stroke, or 4.5% overall. At 1 year, the cumulative mortality rate for 30-day survivors was 1.2% for TIA, 2.4% for ischemic stroke, and 2.9% for intracerebral hemorrhage. While the annual mortality risk after TIA didn’t rise significantly, if any, over time, the cumulative mortality of these “mini-strokes” was substantial at 9.2% after 10 years and 24.9% after 20 years.  Further, while the smaller number of hemorrhagic stroke patients who survived to 30 days resulted in a more variable annual mortality risk ranging from less than 1% to nearly 3%, their long-term cumulative risk was lower than in the first 30 days, at 10.3% after 10 years and 13.7% after 20 years.  The mortality risk over the entire follow-up period compared with an age-, sex-, and year-matched cohort from the no-stroke general population in the Netherlands was consistently elevated after ischemic stroke (26.8% versus 7.6%), though only significantly higher after 10 years post TIA (24.9% versus 8.5%).  The study authors warn that: “Among adults aged 18 through 50 years, 20-year mortality following acute stroke was relatively high compared with expected mortality.“