A Case–Control Study on Risk Factors of Stroke in Young vs. Elderly Patients

Stroke in Young and Elderly Patients

Abstract

Background:
Stroke in young adults represents a significant clinical and socioeconomic burden. Patterns of risk factors and stroke subtypes in younger patients may differ markedly from elderly populations, influencing prevention and management strategies.

Objectives:
To compare the prevalence of vascular risk factors and ischemic stroke subtypes between young and elderly patients, and to identify independent predictors of young stroke.

Methods:
We conducted a community-based case–control study including 180 young stroke patients (18–45 years) and 180 elderly stroke patients (>60 years). Participants were identified through community health records and recent medical consultations. Data on demographics, vascular risk factors, and ischemic stroke subtypes (TOAST classification) were collected. Multivariable logistic regression was applied to determine factors independently associated with young stroke.

Results:
The mean age was 38.2 ± 5.9 years in the young group and 68.4 ± 6.1 years in the elderly group; males comprised 68.9% and 60.0% respectively. Young patients had higher prevalence of smoking/tobacco use (45.0% vs. 30.0%, p=0.003) and alcohol consumption (38.3% vs. 24.4%, p=0.004), whereas elderly patients had higher rates of hypertension (56.7% vs. 35.0%, p<0.001) and diabetes (43.3% vs. 24.4%, p<0.001). Large artery atherosclerosis (38.9% vs. 23.3%, p=0.002) and small vessel disease (30.6% vs. 14.4%, p<0.001) predominated in the elderly, while young patients had more “other determined” (25.0% vs. 6.1%, p<0.001) and undetermined strokes (27.2% vs. 5.6%, p<0.001). In adjusted models, smoking/tobacco use (aOR 1.88, 95% CI 1.20–2.95) and alcohol consumption (aOR 1.85, 95% CI 1.18–2.90) were independent predictors of young stroke, while hypertension (aOR 0.45, 95% CI 0.29–0.70) and diabetes (aOR 0.46, 95% CI 0.28–0.75) favored elderly stroke.

Conclusion:
Young stroke patients exhibit distinct risk factor profiles and etiologic patterns compared to elderly patients, with modifiable behaviors such as smoking and alcohol playing a key role. These findings underscore the importance of targeted primary prevention strategies for young adults at risk.