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Abstract Details

Risk Factors for Recurrence of Vascular Events in Middle-Aged Stroke Survivors
Cerebrovascular Disease and Interventional Neurology
P14 - Poster Session 14 (8:00 AM-9:00 AM)
4-015
To identify risk factors for recurrence of vascular events in middle-aged adults.

Stroke in middle-aged persons is emerging as a distinct entity from previously described "stroke in the young.” Risk factors for recurrence of vascular events in survivors of middle-aged stroke have not been well described in a large, racially diverse US-based population.
We performed a retrospective longitudinal analysis of claims data from all hospitalizations in California (2005-2011), Florida (2005-2014), and New York (2005-2014). We included survivors of first-ever ischemic stroke (IS) and non-traumatic intracerebral hemorrhage (ICH). We defined recurrent vascular events as readmissions with a primary diagnosis of IS, ICH, or myocardial infarction (MI). We used survival analysis and Cox proportional hazards regression to determine factors associated with recurrence risk in middle-aged (40-60 years) versus older (>60 years) adults.
We identified 123,212 non-fatal hospitalizations for a first-ever IS or ICH in middle-aged adults. There were 14,721 readmissions for recurrent vascular events (11.9%) over a mean follow-up of 3.97 years (standard deviation [SD] 2.75 years). In multivariable analyses, black (hazard ratio [HR] 1.44; 95% CI, 1.39-1.50; p<0.001) and Hispanic race (HR 1.10; 95% CI, 1.05-1.16; p<0.001), diabetes (HR 1.76; 95% CI, 1.70-1.82; p<0.001), smoking (HR 1.22; 95% CI, 1.18-1.27; p<0.001), hyperlipidemia (HR 1.08; 95% CI, 1.04-1.12; p<0.001), and hypertension (HR 1.06; 95% CI, 1.03-1.10; p<0.001) were associated with increased recurrence risk. The associations of black race and diabetes were modified by age category (both interactions p<0.001). Black race and diabetes were associated with greater risk in middle-aged versus older adults (black race HR 1.28; 95% CI, 1.25-1.31; p<0.001; diabetes HR 1.27; 95% CI, 1.25-1.30; p<0.001).

Black race and diabetes were the strongest risk factors for recurrence of vascular events in middle-aged adults. Further study of interventions to reduce recurrence and resulting disability in this younger, higher risk population is needed.
Authors/Disclosures
Kevin N. Vanent
PRESENTER 		Mr. Vanent has nothing to disclose.
Audrey Leasure Ms. Leasure has nothing to disclose.
Lindsey R. Kuohn, MD Dr. Kuohn has nothing to disclose.
Oscar R. Benavente, MD, FRCP(C) (Gordon and Leslie Diamond Health Care Centre) No disclosure on file
Ashkan Shoamanesh, MD Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer AG. Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo . Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Servier Inc.. Dr. Shoamanesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurodiem.ca. The institution of Dr. Shoamanesh has received research support from Servier Canada Inc.. The institution of Dr. Shoamanesh has received research support from Daiichi Sankyo Ltd.. The institution of Dr. Shoamanesh has received research support from Bayer AG. The institution of Dr. Shoamanesh has received research support from Bristol-Myers Squibb. The institution of Dr. Shoamanesh has received research support from Octapharma Canada .
Alessandro Biffi, MD (Eli Lilly and Company) Dr. Biffi has received personal compensation for serving as an employee of Eli Lilly And Company. Dr. Biffi has stock in Eli Lilly And Company.
Kevin N. Sheth, MD, FÂ鶹´«Ã½Ó³»­ (Yale UniversityDivision of Neuro and Critical Care) Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Guido J. Falcone, MD (Yale School of Medicine) The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.