{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:44:12Z","timestamp":1791229452351,"version":"4.1.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cause of ischemic stroke in young people is highly variable; however, the risk of recurrence is often presented with all subtypes of stroke grouped together in classification systems such as the Trial of ORG (danaparoid sodium [Orgaran]) 10172 in Acute Stroke Treatment (TOAST) criteria, which limits the ability to individually inform young patients with stroke about their risk of recurrence.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the short-term and long-term risk of recurrent vascular events after ischemic stroke at a young age by stroke cause and to identify factors associated with recurrence.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used data from the Observational Dutch Young Symptomatic Stroke Study, a prospective, multicenter, hospital-based cohort study, conducted at 17 hospitals in the Netherlands between 2013 and 2021. Eligible participants included 30-day survivors of an initial, neuroimaging-proven ischemic stroke (aged 18-49 years). Data analysis was conducted from June to July 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Diagnosis of a first-ever, ischemic stroke via neuroimaging.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n The primary outcome was short-term (within 6 months) and long-term (within 5 years) recurrence risk of any vascular event, defined as fatal or nonfatal recurrent ischemic stroke, transient ischemic attack, myocardial infarction, and revascularization procedure. Predefined characteristics were chosen to identify factors associated with risk of recurrence (cause of stroke, age, sex, stroke severity, and cardiovascular health factors).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 1216 patients (median [IQR] age, 44.2 [38.4-47.7] years; 632 male [52.0%]; 584 female [48.0%]) were included, with a median (IQR) follow-up of 4.3 (2.6-6.0) years. The 6-month risk of any recurrent ischemic event was 6.7% (95% CI, 5.3%-8.1%), and the 5-year risk was 12.2% (95% CI, 10.2%-14.2%)The short-term risk was highest for patients with cervical artery dissections (13.2%; 95% CI, 7.6%-18.7%). Other factors associated with a recurrent short-term event were atherothrombotic stroke, rare causes of stroke, and hypertension. The long-term cumulative risk was highest for patients with atherothrombotic stroke (22.7%; 95% CI, 10.6%-34.7%) and lowest for patients with cryptogenic stroke (5.8%; 95% CI, 3.0%-8.5%). Cardioembolic stroke was associated with a recurrent long-term event, as were diabetes and alcohol abuse.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this cohort study of 1216 patients with an ischemic stroke at a young age suggest that the risk of recurrent vascular events was high and varied by cause of stroke both for short-term and long-term follow-up, including causes that remained concealed when combined into 1 category in the routinely used TOAST criteria. This knowledge will allow for more personalized counseling of young patients with stroke.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.0054","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T11:00:36Z","timestamp":1708426836000},"page":"e240054","source":"Crossref","is-referenced-by-count":33,"title":["Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults"],"prefix":"10.1001","volume":"7","author":[{"given":"Esm\u00e9e","family":"Verburgt","sequence":"first","affiliation":[{"name":"Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina A.","family":"Hilkens","sequence":"additional","affiliation":[{"name":"Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel S.","family":"Ekker","sequence":"additional","affiliation":[{"name":"Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mijntje M. I.","family":"Schellekens","sequence":"additional","affiliation":[{"name":"Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther M.","family":"Boot","sequence":"additional","affiliation":[{"name":"Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maikel H. M.","family":"Immens","sequence":"additional","affiliation":[{"name":"Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayte E.","family":"van Alebeek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Gelre Hospital, Apeldoorn, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J. A. M.","family":"Brouwers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate M.","family":"Arntz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert W.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob A. R.","family":"Gons","sequence":"additional","affiliation":[{"name":"Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge W. M.","family":"van Uden","sequence":"additional","affiliation":[{"name":"Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"den Heijer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sint Franciscus Gasthuis Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia H.","family":"van Tuijl","sequence":"additional","affiliation":[{"name":"Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlijn F.","family":"de Laat","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haga Hospital, The Hague, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk G. W.","family":"van Norden","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amphia Hospital, Breda, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Vermeer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian S. G.","family":"van Zagten","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jeroen Bosch Hospital, \u2018s-Hertogenbosch, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"van Oostenbrugge","sequence":"additional","affiliation":[{"name":"Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke J. H.","family":"Wermer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands"},{"name":"Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Nederkoorn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam University Medical Centre, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk","family":"Kerkhoff","sequence":"additional","affiliation":[{"name":"Department Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fergus A.","family":"Rooyer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zuyderland Hospital, Sittard-Geleen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank G.","family":"van Rooij","sequence":"additional","affiliation":[{"name":"Medical Centre Leeuwarden, Department of Neurology, Leeuwarden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ido R.","family":"van den Wijngaard","sequence":"additional","affiliation":[{"name":"Department of Neurology, Haaglanden Medical Centre, The Hague, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim J. 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