A new study suggested that cohort might have a higher risk of developing a stroke from nontraditional risk factors, such as migraines, than from traditional risks like high blood pressure.
The report in Circulation: Cardiovascular Quality and Outcomes pointed out that most strokes are caused by traditional stroke risk factors, such as high blood pressure, high cholesterol, type 2 diabetes, smoking, obesity, low physical activity, alcohol abuse, or coronary heart disease. The authors were concerned, however, by recent data indicating an increased incidence of strokes even among young adults without these risk factors.
“We wanted to understand which risk factors were the top contributors to stroke risk among young adults,” said lead author Michelle Leppert, MD, MS, MBA, an assistant professor of neurology at the University of Colorado School of Medicine in Aurora.
One of the reasons the study team embarked on the research was that although women have fewer traditional risk factors than men, strokes are more common in women than men aged 45 years and younger. That led to the investigation of the contributions of traditional and nontraditional risk factors, such as migraine and thrombophilia, in the development of strokes among young adults.
The retrospective case-control study used Colorado’s All Payer Claims Database (2012-2019), with researchers identifying identified index stroke events in young adults (aged 18-55 years). The study team matched those 1:3 to stroke-free controls by: 1) sex, 2) age ±2 years, 3) insurance type, and 4) prestroke period. Overall, 2,628 cases were included (52% women; 73.3% ischemic strokes), and 7,827 were controls.
The results indicated that additional traditional and nontraditional risk factors were associated with an increased risk of stroke in all sex and age groups. “In adults aged 18 to 34 years, more strokes were associated with nontraditional (population attributable risk: 31.4% men and 42.7% women) than traditional risk factors (25.3% men and 33.3% women),” the authors pointed out. “The contribution of nontraditional risk factors declined with age (19.4% men and 27.9% women aged 45-55 years).”
They added that the “contribution of traditional risk factors peaked among patients aged 35 to 44 years (32.8% men and 39.7% women).”
The study advised that hypertension was the most important traditional risk factor and increased in contribution with age (population attributable risk: 27.8% men and 26.7% women aged 45 to 55 years). On the other hand, migraine was the most important nontraditional risk factor and decreased in contribution with age (population attributable risk: 20.1% men and 34.5% women aged 18-35 years).
“Nontraditional risk factors were as important as traditional risk factors in the development of strokes for both young men and women and have a stronger association with the development of strokes in adults younger than 35 years of age,” the study concluded.
“These findings are significant because most of our attention has been focused on traditional risk factors,” Dr. Leppert added. “We should not ignore nontraditional stroke risk factors and only focus on traditional risk factors; both are important to the development of strokes among young people.”
“In fact, the younger they are at the time of stroke, the more likely their stroke is due to a nontraditional risk factor,” she said. “We need to better understand the underlying mechanisms of these nontraditional risk factors to develop targeted interventions.”
The most unexpected finding was the large contribution that migraine headaches had in the development of strokes, Dr. Leppert noted, explaining, “There have been many studies demonstrating the association between migraines and strokes, but to our knowledge, this study may be the first to demonstrate just how much stroke risk may be attributable to migraines.”
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