A Comparative Study of Risk Factors across Young and Old Acute Ischemic Strokes: A Hospital-based Study in North India.

Background: Stroke is an important cause of death and disability. Prevalence of stroke differs with age. The risk factors in young differ in comparison to the old age-group. In this study, risk factors of stroke in young are compared to the old age-group.

Aim: To compare the established risk factors in young and old acute ischemic strokes.

Materials And Methods: The study was conducted at the neurosciences department of Santokba Durlabhji Memorial Hospital, Jaipur, a tertiary referral center in North India, from June 2015 to December 2016. It was a hospital-based analytical type of observational, cross-sectional study. One hundred fifty stroke patients above 18 years of age were included in young (<50 years) or old age (>50 years) groups. The risk factors of stroke were defined in terms of hypertension, diabetes mellitus, dyslipidemia, ischemic heart diseases, valvular heart disease, history of transient ischemic attack or stroke, smoking, oral contraceptive pill, raised serum homocysteine, and low serum vitamin B levels.

Results: Of 150 patients, 75 patients were in the young stroke group and 75 patients in the old stroke group. Out of these 150 patients, 66.67% were males and 33.33% were female patients. The mean age (in years) of young patients was 41.64, while in old stroke patients it was 65.8. Thirty-eight percent in the young group and 72% in the old group had hypertension. Diabetes was found in 16% and 32% in the young and old group, respectively. High serum homocysteine was seen in 64% young and 73% old. Low serum vitamin B was found in 25% young and 32% old. Venereal disease research laboratory (VDRL) was reactive in 1.3% in young and 4% in old. Antinuclear antibody (ANA) was positive in 6.6% in young and 2.6% in old. From those tested, antiphospholipid antibody (APLA) was positive in 3.64% in young and 4.16% in old.

Conclusion: Cardioembolic stroke was found equally in old as in young. The number of patients with rheumatic heart disease showed comparatively higher numbers in the young group, while atrial fibrillation was higher in the old age-group, signifying the importance of detailed cardiac workup and Holter monitoring in the old age-group when indicated. Serum vitamin B12 and homocysteine levels should be done routinely in the evaluation of ischemic stroke irrespective of the age of onset of stroke(s), as their levels were impaired equally in both young and old age-groups in our study. Dyslipidemia, traditionally regarded as a risk factor in old, also showed deranged values in the form of raised serum cholesterol and triglycerides in both age-groups. Positive VDRL, ANA, and APLA showed an increased trend in the old age-group in our study compared to the young age-group. Hypertension, diabetes mellitus, and inadequate physical activity were significant risk factors associated with the old group.