Risk of Ischemic Stroke in Young Adults

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Abstract
O besity rates in United States have been steadily increasing throughout the past several decades. In 2011 to 2012, the prevalence of obesity in the United States was 16.9% in youth and 34.9% in adults. 1 Although obesity is a well-recognized risk factor for stroke in older adults 2 and there is evidence for increasing ischemic hospitalization rates for young adults with concurrent increases in obesity, 3 few studies have directly examined the association between obesity and early onset stroke. To evaluate this issue, we used data from a case– control study in the Baltimore–Washington area. Methods The Stroke Prevention in Young Adults Study was designed as a population-based case–control study of young onset ischemic stroke. During 3 study periods between 1992 and 2008, cases with a first-ever ischemic stroke ages 15 to 49 years were identified by discharge surveillance from 59 hospitals in the greater Baltimore/Washington, DC, area and by direct referral from regional neurologists. Controls were matched to cases by age, sex, region of residence, and, except for the initial study phase, were additionally matched for ethnicity. Details of the study design and case adjudication have been previously described. 4 A standardized interview was used to obtain information about stroke risk factors, including age at stroke (or age at interview for controls), ethnicity, smoking status, hypertension, and diabetes mellitus. Height and weight were obtained via self-report during the interview and used to compute body mass index (BMI), calculated as weight (in kg) divided by height (in m) squared. BMI was classified into weight categories according to federal guidelines 5 with participants categorized as underweight (BMI<18.5 kg/m 2), normal weight (18.5–24.9 kg/m 2), overweight (25.0–29.9 kg/m 2), and obese (BMI>30 kg/m 2). We compared stroke risk factors between stroke cases and controls by t tests and χ 2 tests. Odds ratios and confidence intervals were calculated using logistic regression for 3 models: a reduced model adjusted only for age, sex, and race, an intermediate model adjusted for prior covariates and current smoking, and a full model adjusted for these previous covariates plus hypertension and diabetes mellitus. Sequential adjustment was chosen because cigarette smoking is a behavior, whereas hypertension, diabetes mellitus, and obesity cluster together physiologically as a part of the metabolic syndrome. Results The study population included a total of 1201 cases and 1154 controls. Table 1 shows that, compared with controls, cases were slightly older, had higher BMI, …
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