Stroke in young adults: Current trends, opportunities for prevention and pathways forward.

Autor:	Yahya T; Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA., Jilani MH; Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA., Khan SU; Department of Medicine, West Virginia University, Morgantown, WV, USA., Mszar R; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA., Hassan SZ; Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA., Blaha MJ; Ciccarone Center of the Prevention of Cardiovascular Disease, Baltimore, MD, USA., Blankstein R; Harvard Medical School, Harvard University, Boston, MA, USA.; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA., Virani SS; Baylor College of Medicine, Houston, TX, USA.; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA., Johansen MC; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA., Vahidy F; Center for Outcomes Research, Houston Methodist, Houston, TX, USA., Cainzos-Achirica M; Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.; Center for Outcomes Research, Houston Methodist, Houston, TX, USA., Nasir K; Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.; Center for Outcomes Research, Houston Methodist, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	American journal of preventive cardiology [Am J Prev Cardiol] 2020 Sep 09; Vol. 3, pp. 100085. Date of Electronic Publication: 2020 Sep 09 (Print Publication: 2020).
DOI:	10.1016/j.ajpc.2020.100085
Abstrakt:	Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20-44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and loss of productivity, all of which have vast personal, social and economic implications. These concerning trends among young adults are likely due to increasing trends in the prevalence of modifiable risk factors amongst this population including hypertension, hyperlipidemia, obesity and diabetes, highlighting the importance of early detection and aggressive prevention strategies in the general population at early ages. In parallel and compounding to the issue, troublesome trends are evident regarding increasing rates of substance abuse among young adults. Higher rates of strokes have been noted particularly among young African Americans, indicating the need for tailored prevention and social efforts targeting this and other vulnerable groups, including the primordial prevention of risk factors in the first place, reducing stroke rates in the presence of prevalent risk factors such as hypertension, and improving outcomes through enhanced healthcare access. In this narrative review we aim to emphasize the importance of stroke in young adults as a growing public health issue and increase awareness among clinicians and the public health sector. For this purpose, we summarize the available data on stroke in young adults and discuss the underlying epidemiology, etiology, risk factors, prognosis and opportunities for timely prevention of stroke specifically at young ages. Furthermore, this review highlights the gaps in knowledge and proposes future directions moving forward. Competing Interests: Dr. Virani reports grant support: 10.13039/100000738Department of Veterans Affairs, 10.13039/501100015708World Heart Federation, Tahir and Jooma Family Honorarium: 10.13039/100005485American College of Cardiology (Associate Editor for Innovations, acc.org) Steering Committee member: Patient and Provider Assessment of Lipid Management (PAM) registry at the 10.13039/100006513Duke Clinical Research Institute (no financial remuneration). Dr. Ron Blankstein reports research support from 10.13039/100002429Amgen Inc and 10.13039/100004324Astellas Inc. The other authors have no conflicts of interest relevant to the content of this manuscript. (© 2020 The Authors.)
Databáze:	MEDLINE
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