Cardiovascular events and mortality in the long term in young patients with acute disorders of ­cerebral circulation

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Abstract

This review presents the results of various studies on the problem of cardiovascular events and the risk of their development as well as long-term mortality in young patients with cerebrovascular accidents or strokes. In recent decades, there has been a tendency to rejuvenation of cerebrovascular diseases often leading to fatal outcomes. At present, the question of the course of stroke in the acute stage of the disease is most studied. Meanwhile, the study of late, including long-term (5 years or more) results of the stroke is important for planning the organization of medical care using the principles of evidence-based medicine. The long-term prognosis for young patients who underwent strokes is of particular interest from a medical and social point of view due to the increase of life expectancy and basic responsibilities at a difficult stage of life. According to a meta-analysis carried out on the results of prospective studies, it was found that the prognosis of a “young” stroke is not as favorable as it was previously thought with respect to the development of cardiovascular diseases or psychosocial consequences as well as mortality. It was shown that the risk of death among young patients aged 18 to 49 years who survived a 30-day primary stroke, compared to the risk of death in the general population, remained increased even after 15 years. However, this issue remains still insufficiently studied. Further research is needed in this area.

About the authors

A R Shamkina

Kazan State Medical University

Author for correspondence.
Email: schamkina.aigul@yandex.ru
Russian Federation, Kazan, Russia

Sh Sh Galeeva

Kazan State Medical University

Email: schamkina.aigul@yandex.ru
Russian Federation, Kazan, Russia

References

  1. Alberts M.J. Ischemic stroke. Cerebrovasc. Dis. 2002; 13 (suppl. 1): 12–16. doi: 10.1159/000047784.
  2. Benjamin E.J., Virani S.S., Callaway C.W. et al. Heart Disease and Stroke Statistics — 2018 Update: A Report From the American Heart Association. Circulation. 2018; 137: 67–492. doi: 10.1161/CIR.0000000000000558.
  3. The Burden of Stroke in Europe. London: Stroke Alliance for Europe. 2015; 108 p.
  4. Polikarpov A.V., Aleksandrova G.A., Golubev N.A. Zabolevaemost' vsego naseleniya Rossii v 2017 godu. Statisticheskie materialy. (Morbidity of the whole population of Russia in 2017. Statistical materials.) Moscow. 2018; 140 p. (In Russ.)
  5. Boytsov S.A., Martsevich S.J., Kutishenko N.P. et al. The study “Register of patients after acute stroke (region)”. Part 1. Hospital prospective register of patients after acute stroke (according to the results of the pilot phase of the study). Ratsional'naya farmakoterapiya v kardiologii. 2016; 6: 645–653. (In Russ.)
  6. Burtsev E.M. Violation of cerebral circulation at a young age. Klinicheskaya meditsina. 1986; (9): 30–36. (In Russ.)
  7. Begidova N.M., Ulimbasheva E.S., Chudopal S.M. Pathogenetic subtypes and risk factors for stroke in young people in Kabardino-Balkaria. Neyroimmunologiya. 2003; (2): 19. (In Russ.)
  8. Yesilot Barlas N., Putaala J., Waje-Andreassen U. et al. Etiology of first-ever ischemic stroke in European young adults: the 15 Cities Young Stroke Study. Eur. J. Neurol. 2013; 20 (11): 1431–1439. doi: 10.1111/ene.12228.
  9. Dževdet S. Strokes in young adults: epidemiology and prevention. Vasc. Health Risk Manag. 2015; 11: 157–164. doi: 10.2147/VHRM.S53203.
  10. Bejot Y., Delpont B., Giroud M. Rising stroke incidence in young adults: more epidemiological evidence, more questions to be answered. J. Am. Heart Assoc. 2016; 11 (5): 5–12. doi: 10.1161/JAHA.116.003661.
  11. Schöberl F., Ringleb P.A., Wakili R. et al. Juvenile Stroke: A Practice-Oriented Overview. Dtsch. Arztebl. Int. 2017; 114 (31–32): 527–534. doi: 10.3238/arztebl.2017.0527.
  12. Fischer M., Eckert B., Röther J. Juvenile stroke — what is important? Nervenarzt. 2018; 89 (2): 124–135. doi: 10.1007/s00115-016-0276-9.
  13. Shah R., Wilkins E., Nichols M. et al. Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data. Eur. Heart J. 2019; 40 (9): 755–764. doi: 10.1093/eurheartj/ehy378.
  14. Skvortsova V.I., Shetova I.M., Kakorina E.P. et al. Reducing mortality from acute disorders of cerebral circulation as a result of the implementation of a set of measures to improve medical care for patients with vascular diseases in the Russian Federation. Profilakticheskaya meditsina. 2018; 21 (1): 4–10. (In Russ.)
  15. Klinicheskie rekomendacii po provedeniyu tromboliticheskoy terapii u patsientov s ishemicheskim insul'tom. (Clinical recommendations for thrombolytic therapy in patients with ischemic stroke.) Moscow. 2015: 1–34. (In Russ.)
  16. Samorodskaya I.V., Zayrat'yants O.V., Perkhov V.I. et al. Dynamics of mortality rates from acute cerebrovascular accident in Russia and the United States for the 15-year period. Arkhiv patologii. 2018; 80 (2): 30–37. (In Russ.)
  17. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc. Health Risk Manag. 2015; 11: 157–164. doi: 10.2147/VHRM.S53203.
  18. Ekker M.S., Verhoeven J.I., Vaartjes I. et al. Association of stroke among adults aged 18 to 49 years with long-term mortality. JAMA. 2019; 321 (21): 2113–2123. doi: 10.1001/jama.2019.6560.
  19. Feigin V.L., Barker-Collo S., Parag V. et al. Auckland Stroke Outcomes Study: part 1: gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. Neurology. 2010; 75: 1597–1607. doi: 10.1212/WNL.0b013e3181fb44b3.
  20. Dhamoon M.S., Tai W., Boden-Albala B. et al. Risk of myocardial infarction or vascular death after first ische­mic stroke. Stroke. 2007; 38: 1752–1758. doi: 10.1161/STROKEAHA.106.480988.
  21. Kulesh S.D., Likhachev S.A., Filina N.A. et al. Five-year survival after stroke. Annaly klinicheskoy i eksperimental'noy nevrologii. 2012; 6 (1): 14–19. (In Russ.)
  22. European Cardiovascular Disease Statistics. 2017; 192 p.
  23. Zdravookhranenie v Rossii. Statisticheskiy sbornik. (Health in Russia. Statistical compendium.) Moscow: Rosstat. 2011; 326 p. (In Russ.)
  24. Warlow C.P., Dennis M.S., van Gijn J. et al. Stroke: a practical guide to management. Blackwell Science, Oxford. 2001: 223–300. Russ. ed.: Insul't: prakticheskoe rukovodstvo dlya vede­niya bol'nyh. Sankt-­Peterburg: Politekhnika. 1998; 629 p. (In Russ.)
  25. Insul't: diagnostika, lechenie, profilaktika. (Stroke: diagnosis, treatment, prevention.) Ed. by Z.A. Suslina, M.A. Piradov. Moscow: MEDpress-­inform. 2009; 288 p. (In Russ.)
  26. Kappelle L.J., Adams H.P.Jr., Heffner M.L. et al. Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke. 1994; 25 (7): 1360–1365. doi: 10.1161/01.str.25.7.1360.
  27. Aarnio K., Rodríguez-Pardo J., Siegerink B. et al. Return to work after ischemic stroke in young adults. A registry-based follow-up study. Neurology. 2018; 91 (20): 1909–1917. doi: 10.1212/WNL.0000000000006510.
  28. Varona J.F., Bermejo F., Guerra J.M., Molina J.A. Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J. Neurol. 2004; 251 (12): 1507–1514. doi: 10.1007/s00415-004-0583-0.
  29. Spengos K., Vemmos K. Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 — the Athens young stroke registry. Eur. J. Neurol. 2010; 17 (11): 1358–1364. doi: 10.1111/j.1468-1331.2010.03065.x.
  30. Putaala J., Haapaniemi E., Gordin D. et al. Factors associated with impaired kidney function and its impact on long-term outcome in young ischemic stroke. Stroke. 2011; 42 (9): 2459–2464. doi: 10.1161/STROKEAHA.110.612721.
  31. Putaala J., Haapaniemi E., Kaste M., Tatlisumak T. How does number of risk factors affect prognosis in young patients with ischemic stroke? Stroke. 2012; 43 (2): 356–361. doi: 10.1161/STROKEAHA.111.635276.
  32. Gastrich M.D., Gandhi S.K., Pantazopoulos J. et al. Cardiovascular outcomes after preeclampsia or eclampsia complicated by myocardial infarction or stroke. Obstet. Gynecol. 2012; 120 (4): 823–831. doi: 10.1097/AOG.0b013e31826ae78a.
  33. Maaijwee N.A., Rutten-Jacobs L.C., Schaapsmeer­ders P. et al. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat. Rev. Neurol. 2014; 10 (6): 315–325. doi: 10.1038/nrneurol.2014.72.
  34. Rutten-Jacobs L.C., Maaijwee N.A., Arntz R.M. et al. Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Ann. Neurol. 2013; 74 (4): 592–601. doi: 10.1002/ana.23953.
  35. Rutten-Jacobs L.C., Arntz R.M., Maaijwee N.A. et al. Cardiovascular disease is the main cause of long-term excess mortality after ischemic stroke in young adults. Hypertension. 2015; 65 (3): 670–675. doi: 10.1161/HYPERTENSIONAHA.114.04895.
  36. De Bruijn M.A., Synhaeve N.E., van Rijsbergen M.W. et al. Quality of life after young ischemic stroke of mild severity is mainly influenced by psychological factors. J. Stroke Cerebrovasc. Dis. 2015; 10: 2183–2188. doi: 10.1016/j.jstrokecerebrovasdis.2015.04.040.
  37. Aarnio K., Siegerink B., Pirinen J. et al. Cardiovascular events after ischemic stroke in young adults: A prospective follow-up study. Neurology. 2016; 86 (20): 1872–1879. doi: 10.1212/WNL.0000000000002689.
  38. Pirinen J., Putaala J., Aarnio K. et al. Are 12-lead ECG findings associated with the risk of cardiovascular events after ischemic stroke in young adults? Ann. Med. 2016; 48 (7): 532–540. doi: 10.1080/07853890.2016.1202443.
  39. Mustanoja S., Putaala J., Koivunen R.J. et al. Blood pressure levels in the acute phase after intracerebral hemorrhage are associated with mortality in young adults. Eur. J. Neurol. 2018; 25 (8): 1034–1040. doi: 10.1111/ene.13662.
  40. Edwards J.D., Kapral M.K., Lindsay M.P. et al. Young stroke survivors with no early recurrence at high long-term risk of adverse outcomes. J. Am. Heart Assoc. 2019; 8 (1): e010370. doi: 10.1161/JAHA.118.010370.
  41. Kaplan R.C., Tirschwell D.L., Longstreth W.T.Jr. et al. Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke. J. Am. Geriatr. Soc. 2006; 54 (9): 1309–1316. doi: 10.1111/j.1532-5415.2006.00838.x.
  42. Fonyakin A.V., Geraskina L.A., Shandlin V.A. et al. Сardiovascular complications in post-stroke period and heart rate variability. Kreativnaya kardiologiya. 2011; (1): 91–101. (In Russ.)
  43. Ntaios G., Papavasileiou V., Makaritsis K. et al. Association of ischaemic stroke subtype with longterm cardiovascular events. Eur. J. Neurol. 2014; 21: 1108–1114. doi: 10.1111/ene.12438.
  44. Goeh Akue E., Afassinou Y.M., Ido B.J. et al. Vascular age and cardiovascular risk in patients suffering from stroke. Ann. Cardiol. Angeiol. (Paris). 2015; 64 (3): 128–131. doi: 10.1016/j.ancard.2015.04.008.
  45. Martsevich S.Yu., Kutishenko N.P., Suvorov A.V. et al. The main factors affecting the long-term outcomes in patients after acute cerebrovascular disorder: results of the LIS-2 study. Ratsional'naya farmakoterapiya v kardiologii. 2016; 12 (1): 51–55. (In Russ.)
  46. Amarenco P., Lavallée P.C., Monteiro Tavares L. et al. Five-year risk of stroke after TIA or minor ischemic stroke. N. Engl. J. Med. 2018; 378 (23): 2182–2190. doi: 10.1056/NEJMoa1802712.
  47. Pana T.A., Wood A.D., Mamas M.A. et al. Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors. Acta. Neurol. Scand. 2019; 140 (3): 219–228. doi: 10.1111/ane.13135.
  48. Rus Mansilla C., Mesa Rubio D., Suárez de Lezo Cruz Conde J. et al. Utility of transesophageal echocar­diography in young patients with cryptogenic stroke and low cardiovascular risk. Med. Clin. (Barc.). 2008; 130 (7): 241–245. doi: 10.1157/13116547.
  49. Gürdal A., Keskin K., Orken D.N. et al. Evaluation of epicardial fat thickness in young patients with embolic stroke of undetermined source. Neurologist. 2018; 23 (4): 113–117. doi: 10.1097/NRL.0000000000000182.
  50. Martinez-Majander N., Aarnio K., Pirinen J. et al. Embolic strokes of undetermined source in young adults: baseline characteristics and long-term outcome. Eur. J. Neurol. 2018; 25 (3): 535–541. doi: 10.1111/ene.13540.
  51. Kaikita K. Epicardial adipose tissue as a predictor for the development of non-calcified coronary plaque. J. Atheroscler. Thromb. 2017; 24 (3): 254–255. doi: 10.5551/jat.ED062.
  52. Uchasova E.G., Gruzdeva O.V., Dyleva J.A. et al. Epicardial adi­pose tissue: pathophysiology and role in the development of cardiovascular diseases. Bjulleten' sibirskoy meditsiny. 2018; 17 (4): 254–263. (In Russ.)
  53. Trial of secondary prevention with atenolol after transient ischemic attack or no disabling ischemic stroke. The Dutch TIA Study Group. Stroke. 1993; 24: 543–548. doi: 10.1161/01.str.24.4.543.
  54. Schrader J.S., Luders S., Kulschewski A. et al. Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention principal results of a prospective randomized controlled study (MOSES). Stroke. 2005; 36: 1218–1226. doi: 10.1161/01.STR.0000166048.35740.a9.
  55. Amarenco P., Bogousslavsky J., Callahan A. et al. For the SPARCL investigators. Highdose atorvastatin after stroke or transient ischemic attack. N. Engl. J. Med. 2006; 355: 549–559.
  56. Bousser M.G., Amarenco P., Chamorro A. et al. The Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack (PERFORM) study: baseline characteristics of the popu­lation. Cerebrovasc. Dis. 2009; 27 (6): 608–613. doi: 10.1159/000216835.
  57. Hong K.S., Kim B.J., Lee J.Y. et al. Rationale and design of the PreventIon of Cardiovascular events in iSche­mic Stroke patients with high risk of cerebral hemOrrhage (PICASSO) study: A randomized controlled trial. Int. J. Stroke. 2015; 10 (7): 1153–1158. doi: 10.1111/ijs.12519.
  58. Van Dongen M.M.E., Aarnio K., Martinez-­Majander N. et al. Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome. Ann. Med. 2019; 51 (1): 68–77. doi: 10.1080/07853890.2018.1564358.

© 2020 Shamkina A.R., Galeeva S.S.

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