Skip to main content
Top
Published in: BMC Neurology 1/2020

Open Access 01-12-2020 | Stroke | Research article

Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study

Authors: Nan Zhang, Lin Zhang, Qiu Wang, Jingwei Zhao, Jia Liu, Guang Wang

Published in: BMC Neurology | Issue 1/2020

Login to get access

Abstract

Background

Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes.

Methods

This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models.

Results

We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively).

Conclusions

In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.
Literature
1.
go back to reference Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012;79:1781–7.PubMedPubMedCentralCrossRef Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012;79:1781–7.PubMedPubMedCentralCrossRef
2.
go back to reference Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, et al. Recognition and management of stroke in young adults and adolescents. Neurology. 2013;81:1089–97.PubMedPubMedCentralCrossRef Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, et al. Recognition and management of stroke in young adults and adolescents. Neurology. 2013;81:1089–97.PubMedPubMedCentralCrossRef
3.
go back to reference Siriratnam P, Godfrey A, O'Connor E, Pearce D, Hu CC, Low A, et al. Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective. Intern Med J. 2020;50(6):698–704.PubMedCrossRef Siriratnam P, Godfrey A, O'Connor E, Pearce D, Hu CC, Low A, et al. Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective. Intern Med J. 2020;50(6):698–704.PubMedCrossRef
4.
go back to reference Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17:790–801.PubMedCrossRef Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17:790–801.PubMedCrossRef
5.
go back to reference Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. 2014;10:315–25.PubMedCrossRef Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. 2014;10:315–25.PubMedCrossRef
6.
go back to reference Maaijwee NA, Rutten-Jacobs LC, Arntz RM, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, et al. Long-term increased risk of unemployment after young stroke: a long-term follow-up study. Neurology. 2014;83:1132–8.PubMedCrossRef Maaijwee NA, Rutten-Jacobs LC, Arntz RM, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, et al. Long-term increased risk of unemployment after young stroke: a long-term follow-up study. Neurology. 2014;83:1132–8.PubMedCrossRef
7.
go back to reference Ekker MS, Verhoeven JI, Vaartjes I, van Nieuwenhuizen KM, Klijn CJM, de Leeuw FE. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019;92(21):e2444–54.PubMedCrossRef Ekker MS, Verhoeven JI, Vaartjes I, van Nieuwenhuizen KM, Klijn CJM, de Leeuw FE. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019;92(21):e2444–54.PubMedCrossRef
8.
go back to reference Vangen-Lonne AM, Wilsgaard T, Johnsen SH, Carlsson M, Mathiesen EB. Time trends in incidence and case fatality of ischemic stroke: the tromso study 1977–2010. Stroke. 2015;46:1173–9.PubMedCrossRef Vangen-Lonne AM, Wilsgaard T, Johnsen SH, Carlsson M, Mathiesen EB. Time trends in incidence and case fatality of ischemic stroke: the tromso study 1977–2010. Stroke. 2015;46:1173–9.PubMedCrossRef
9.
go back to reference Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017;48:1744–51.PubMedCrossRef Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017;48:1744–51.PubMedCrossRef
10.
go back to reference Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020;91(4):411–7.PubMedCrossRef Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020;91(4):411–7.PubMedCrossRef
11.
go back to reference Tuttolomondo A, Maida C, Pinto A. Diabetic foot syndrome: immune-inflammatory features as possible cardiovascular markers in diabetes. World J Orthop. 2015;6(1):62–76.PubMedPubMedCentralCrossRef Tuttolomondo A, Maida C, Pinto A. Diabetic foot syndrome: immune-inflammatory features as possible cardiovascular markers in diabetes. World J Orthop. 2015;6(1):62–76.PubMedPubMedCentralCrossRef
12.
go back to reference Xu YJ, Tappia PS, Neki NS, Dhalla NS. Prevention of diabetes-induced cardiovascular complications upon treatment with antioxidants. Heart Fail Rev. 2014;19(1):113–21.PubMedCrossRef Xu YJ, Tappia PS, Neki NS, Dhalla NS. Prevention of diabetes-induced cardiovascular complications upon treatment with antioxidants. Heart Fail Rev. 2014;19(1):113–21.PubMedCrossRef
13.
go back to reference G, Fava I, Petrella A, Barbieri M, Paolisso G. Cryptogenic stroke and diabetes: a probable link between silent atrial fibrillation episodes and cerebrovascular disease. Expert Rev Cardiovasc Ther. 2014;12(3):323–9.CrossRef G, Fava I, Petrella A, Barbieri M, Paolisso G. Cryptogenic stroke and diabetes: a probable link between silent atrial fibrillation episodes and cerebrovascular disease. Expert Rev Cardiovasc Ther. 2014;12(3):323–9.CrossRef
14.
15.
go back to reference Pirastehfar M, Katz P, Gentile NT, Jacobi JE, Linares G. Abstract WP208: incidence of ischemic stroke in young adults, a 4 year retrospective review from an urban tertiary Care Center in North Philadelphia. Stroke. 2016;47:AWP208. Pirastehfar M, Katz P, Gentile NT, Jacobi JE, Linares G. Abstract WP208: incidence of ischemic stroke in young adults, a 4 year retrospective review from an urban tertiary Care Center in North Philadelphia. Stroke. 2016;47:AWP208.
16.
go back to reference Lipska K, Sylaja PN, Sarma PS, Thankappan KR, Kutty VR, Vasan RS, et al. Risk factors for acute ischaemic stroke in young adults in South India. J Neurol Neurosurg Psychiatry. 2007;78:959–63.PubMedPubMedCentralCrossRef Lipska K, Sylaja PN, Sarma PS, Thankappan KR, Kutty VR, Vasan RS, et al. Risk factors for acute ischaemic stroke in young adults in South India. J Neurol Neurosurg Psychiatry. 2007;78:959–63.PubMedPubMedCentralCrossRef
17.
go back to reference Albucher JF, Ferrieres J, Ruidavets JB, Guiraud-Chaumeil B, Perret BP, Chollet F. Serum lipids in young patients with ischaemic stroke: a case-control study. J Neurol Neurosurg Psychiatry. 2000;69:29–33.PubMedPubMedCentralCrossRef Albucher JF, Ferrieres J, Ruidavets JB, Guiraud-Chaumeil B, Perret BP, Chollet F. Serum lipids in young patients with ischaemic stroke: a case-control study. J Neurol Neurosurg Psychiatry. 2000;69:29–33.PubMedPubMedCentralCrossRef
18.
go back to reference Kivioja R, Pietilä A, Martinez-Majander N, Gordin D, Havulinna AS, Salomaa V, et al. Risk factors for early-onset ischemic stroke: a case-control study. J Am Heart Assoc. 2018;7(21):e009774.PubMedPubMedCentralCrossRef Kivioja R, Pietilä A, Martinez-Majander N, Gordin D, Havulinna AS, Salomaa V, et al. Risk factors for early-onset ischemic stroke: a case-control study. J Am Heart Assoc. 2018;7(21):e009774.PubMedPubMedCentralCrossRef
19.
go back to reference Shahar E, Chambless LE, Rosamond WD, Boland LL, Ballantyne CM, McGovern PG, et al. Plasma lipid profile and incident ischemic stroke: the atherosclerosis risk in communities (ARIC) study. Stroke. 2003;34:623–31.PubMedCrossRef Shahar E, Chambless LE, Rosamond WD, Boland LL, Ballantyne CM, McGovern PG, et al. Plasma lipid profile and incident ischemic stroke: the atherosclerosis risk in communities (ARIC) study. Stroke. 2003;34:623–31.PubMedCrossRef
20.
go back to reference Yeh PS, Yang CM, Lin SH, Wang WM, Chen PS, Chao TH, et al. Low levels of high-density lipoprotein cholesterol in patients with atherosclerotic stroke: a prospective cohort study. Atherosclerosis. 2013;228:472–7.PubMedCrossRef Yeh PS, Yang CM, Lin SH, Wang WM, Chen PS, Chao TH, et al. Low levels of high-density lipoprotein cholesterol in patients with atherosclerotic stroke: a prospective cohort study. Atherosclerosis. 2013;228:472–7.PubMedCrossRef
21.
go back to reference Mei L, Fang X, Mu L, Liu H, Zhang H, Qin X, et al. Association of serum high density lipoprotein cholesterol level and risk of recurrent ischemic stroke. Zhonghua Xin Xue Guan Bing Za Zhi. 2014;42:295–300.PubMed Mei L, Fang X, Mu L, Liu H, Zhang H, Qin X, et al. Association of serum high density lipoprotein cholesterol level and risk of recurrent ischemic stroke. Zhonghua Xin Xue Guan Bing Za Zhi. 2014;42:295–300.PubMed
22.
go back to reference Sanossian N, Saver JL, Kim D, Razinia T, Ovbiagele B. Do high-density lipoprotein cholesterol levels influence stroke severity ? J Stroke Cerebrovasc Dis. 2006;15(5):187–9.PubMedCrossRef Sanossian N, Saver JL, Kim D, Razinia T, Ovbiagele B. Do high-density lipoprotein cholesterol levels influence stroke severity ? J Stroke Cerebrovasc Dis. 2006;15(5):187–9.PubMedCrossRef
23.
go back to reference Van der Stoep M, Korporaal SJ, Van Eck M. High-density lipoprotein as a modulator of latelet and coagulation responses. Cardiovasc Res. 2014;103:362–71.PubMedCrossRef Van der Stoep M, Korporaal SJ, Van Eck M. High-density lipoprotein as a modulator of latelet and coagulation responses. Cardiovasc Res. 2014;103:362–71.PubMedCrossRef
24.
go back to reference Kerry-Anne R. Barter Philip J. Cardioprotective functions of HDLs. J Lipid Res. 2014;55:168–79.CrossRef Kerry-Anne R. Barter Philip J. Cardioprotective functions of HDLs. J Lipid Res. 2014;55:168–79.CrossRef
25.
go back to reference Amarenco P, Labreuche J, Touboul PJ. High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review. Atherosclerosis. 2008;196:489–96.PubMedCrossRef Amarenco P, Labreuche J, Touboul PJ. High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review. Atherosclerosis. 2008;196:489–96.PubMedCrossRef
26.
go back to reference Lapergue B, Moreno JA, Dang BQ, Coutard M, Delbosc S, Raphaeli G, et al. Protective effect of high-density lipoprotein-based therapy in a model of embolic stroke. Stroke. 2010;41(7):1536–42.PubMedCrossRef Lapergue B, Moreno JA, Dang BQ, Coutard M, Delbosc S, Raphaeli G, et al. Protective effect of high-density lipoprotein-based therapy in a model of embolic stroke. Stroke. 2010;41(7):1536–42.PubMedCrossRef
27.
go back to reference Suda S, Shimoyama T, Nagai K, Arakawa M, Aoki J, Kanamaru T, et al. Low free Triiodothyronine predicts 3-month poor outcome after acute stroke. J Stroke Cerebrovasc Dis. 2018;27(10):2804–9.PubMedCrossRef Suda S, Shimoyama T, Nagai K, Arakawa M, Aoki J, Kanamaru T, et al. Low free Triiodothyronine predicts 3-month poor outcome after acute stroke. J Stroke Cerebrovasc Dis. 2018;27(10):2804–9.PubMedCrossRef
28.
29.
go back to reference Zhang S, Zhao X, Xu S, Yuan J, Si Z, Yang Y, et al. Low free triiodothyronineis predicts worsen neurological outcome of patients with acute ischemic stroke: a retrospective study with bioinformatics analysis. BMC Neurol. 2019;19(1):272.PubMedPubMedCentralCrossRef Zhang S, Zhao X, Xu S, Yuan J, Si Z, Yang Y, et al. Low free triiodothyronineis predicts worsen neurological outcome of patients with acute ischemic stroke: a retrospective study with bioinformatics analysis. BMC Neurol. 2019;19(1):272.PubMedPubMedCentralCrossRef
30.
go back to reference Jiang X, Xing H, Wu J, Du R, Liu H, Chen J, et al. Prognostic value of thyroid hormones in acute ischemic stroke - a meta analysis. Sci Rep. 2017;7(1):16256.PubMedPubMedCentralCrossRef Jiang X, Xing H, Wu J, Du R, Liu H, Chen J, et al. Prognostic value of thyroid hormones in acute ischemic stroke - a meta analysis. Sci Rep. 2017;7(1):16256.PubMedPubMedCentralCrossRef
31.
go back to reference Lamba N, Liu C, Zaidi H, Broekman MLD, Simjian R, Shi C, et al. A prognostic role for low triiodothyronine syndrome in acute stroke patients: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;169:55–63.PubMedCrossRef Lamba N, Liu C, Zaidi H, Broekman MLD, Simjian R, Shi C, et al. A prognostic role for low triiodothyronine syndrome in acute stroke patients: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;169:55–63.PubMedCrossRef
32.
go back to reference Suda S, Muraga K, Kanamaru T, Okubo S, Abe A, Aoki J, et al. Low free triiodothyronine predicts poor functional outcome after acute ischemic stroke. J Neurol Sci. 2016;368:89–93.PubMedCrossRef Suda S, Muraga K, Kanamaru T, Okubo S, Abe A, Aoki J, et al. Low free triiodothyronine predicts poor functional outcome after acute ischemic stroke. J Neurol Sci. 2016;368:89–93.PubMedCrossRef
33.
go back to reference Feng X, Zhou X, Yu F, Liu Z, Wang J, Li Z, et al. Low-normal free triiodothyronine and high leukocyte levels in relation to stroke severity and poor outcome in acute ischemic stroke with intracranial atherosclerotic stenosis. Int J Neurosci. 2019;129(7):635–41.PubMedCrossRef Feng X, Zhou X, Yu F, Liu Z, Wang J, Li Z, et al. Low-normal free triiodothyronine and high leukocyte levels in relation to stroke severity and poor outcome in acute ischemic stroke with intracranial atherosclerotic stenosis. Int J Neurosci. 2019;129(7):635–41.PubMedCrossRef
34.
go back to reference Li LQ, Xu XY, Li WY, Hu X-Y, Lv W. The prognostic value of total T3 after acute cerebral infarction is age-dependent: a retrospective study on 768 patients. BMC Neurol. 2019;19(1):54.PubMedPubMedCentralCrossRef Li LQ, Xu XY, Li WY, Hu X-Y, Lv W. The prognostic value of total T3 after acute cerebral infarction is age-dependent: a retrospective study on 768 patients. BMC Neurol. 2019;19(1):54.PubMedPubMedCentralCrossRef
35.
go back to reference van den Beld AW, Visser TJ, Feelders RA, Grobbee DE, Lamberts SW. Thyroid hormone concentrations, disease, physical function, and mortality in elderly men. J Clin Endocrinol Metab. 2005;90(12):6403–9.PubMedCrossRef van den Beld AW, Visser TJ, Feelders RA, Grobbee DE, Lamberts SW. Thyroid hormone concentrations, disease, physical function, and mortality in elderly men. J Clin Endocrinol Metab. 2005;90(12):6403–9.PubMedCrossRef
36.
go back to reference Strich D, Karavani G, Edri S, Chay C, Gillis D. FT3 is higher in MALES THAN in FEMALES and decreases OVER the lifespan. Endocr Pract. 2017;23(7):803–7.PubMedCrossRef Strich D, Karavani G, Edri S, Chay C, Gillis D. FT3 is higher in MALES THAN in FEMALES and decreases OVER the lifespan. Endocr Pract. 2017;23(7):803–7.PubMedCrossRef
37.
go back to reference Mdzinarishvili A, Sutariya V, Talasila PK, Geldenhuys WJ, Sadana P. Engineering triiodothyronine (T3) nanoparticle for use in ischemic brain stroke. Drug Deliv Transl Res. 2013;3(4):309–17.PubMedCrossRef Mdzinarishvili A, Sutariya V, Talasila PK, Geldenhuys WJ, Sadana P. Engineering triiodothyronine (T3) nanoparticle for use in ischemic brain stroke. Drug Deliv Transl Res. 2013;3(4):309–17.PubMedCrossRef
38.
go back to reference Sayre NL, Sifuentes M, Holstein D, Cheng SY, Zhu X, Lechleiter JD. Stimulation of astrocyte fatty acid oxidation by thyroid hormone is protective against ischemic stroke-induced damage. J Cereb Blood Flow Metab. 2017;37(2):514–27.PubMedCrossRef Sayre NL, Sifuentes M, Holstein D, Cheng SY, Zhu X, Lechleiter JD. Stimulation of astrocyte fatty acid oxidation by thyroid hormone is protective against ischemic stroke-induced damage. J Cereb Blood Flow Metab. 2017;37(2):514–27.PubMedCrossRef
39.
go back to reference Talhada D, Feiteiro J, Costa AR, Talhada T, Cairrão E, Wieloch T, et al. Triiodothyronine modulates neuronal plasticity mechanisms to enhance functional outcome after stroke. Acta Neuropathol Commun. 2019;7(1):216.PubMedPubMedCentralCrossRef Talhada D, Feiteiro J, Costa AR, Talhada T, Cairrão E, Wieloch T, et al. Triiodothyronine modulates neuronal plasticity mechanisms to enhance functional outcome after stroke. Acta Neuropathol Commun. 2019;7(1):216.PubMedPubMedCentralCrossRef
40.
go back to reference Sadana P, Coughlin L, Burke J, Woods R, Mdzinarishvili A. Anti-edema action of thyroid hormone in MCAO model of ischemic brain stroke: possible association with AQP4 modulation. J Neurol Sci. 2015;354(1–2):37–45.PubMedCrossRef Sadana P, Coughlin L, Burke J, Woods R, Mdzinarishvili A. Anti-edema action of thyroid hormone in MCAO model of ischemic brain stroke: possible association with AQP4 modulation. J Neurol Sci. 2015;354(1–2):37–45.PubMedCrossRef
41.
go back to reference Wu G-H, Kong F-Z, Cheng Q-Z, Luo W-F, Du X-D. Low T3 syndrome predicts severe neurological deficits of cerebral infarction inpatients with large artery artherosclerosis in internal carotid artery system. Neuro Endocrinol Lett. 2014;35:149–53.PubMed Wu G-H, Kong F-Z, Cheng Q-Z, Luo W-F, Du X-D. Low T3 syndrome predicts severe neurological deficits of cerebral infarction inpatients with large artery artherosclerosis in internal carotid artery system. Neuro Endocrinol Lett. 2014;35:149–53.PubMed
42.
go back to reference Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.PubMedCrossRef Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.PubMedCrossRef
43.
go back to reference Li CJ, Du XX, Yang K, Song LP, Li PK, Wang Q, et al. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients. Neural Regen Res. 2016;11(11):1766–72.PubMedPubMedCentralCrossRef Li CJ, Du XX, Yang K, Song LP, Li PK, Wang Q, et al. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients. Neural Regen Res. 2016;11(11):1766–72.PubMedPubMedCentralCrossRef
44.
go back to reference Toyoda K, Uwatoko T, Shimada T, Hagiwara N, Fujimoto S, Ibayashi S, et al. Recurrent small-artery disease in hyperhomocysteinemia: widowers' stroke syndrome? Intern Med. 2004;43(9):869–72.PubMedCrossRef Toyoda K, Uwatoko T, Shimada T, Hagiwara N, Fujimoto S, Ibayashi S, et al. Recurrent small-artery disease in hyperhomocysteinemia: widowers' stroke syndrome? Intern Med. 2004;43(9):869–72.PubMedCrossRef
45.
go back to reference Madonna P, de Stefano V, Coppola A, Cirillo F, Cerbone AM, Orefice G, et al. Hyperhomocysteinemia and other inherited prothrombotic conditions in young adults with a history of ischemic stroke. Stroke. 2002;33:51–6.PubMedCrossRef Madonna P, de Stefano V, Coppola A, Cirillo F, Cerbone AM, Orefice G, et al. Hyperhomocysteinemia and other inherited prothrombotic conditions in young adults with a history of ischemic stroke. Stroke. 2002;33:51–6.PubMedCrossRef
46.
go back to reference Zhang S, Chang C, Zhang J, Song B, Xu Y. Reconsideration for ischemic stroke risk factors in youth. Zhonghua Yi Xue Za Zhi. 2014;94(25):1936–40.PubMed Zhang S, Chang C, Zhang J, Song B, Xu Y. Reconsideration for ischemic stroke risk factors in youth. Zhonghua Yi Xue Za Zhi. 2014;94(25):1936–40.PubMed
47.
go back to reference Han L, Wu Q, Wang C, Hao Y, Zhao J, Zhang L, et al. Homocysteine, ischemic stroke, and coronary heart disease in hypertensive patients: a population-based, prospective cohort study. Stroke. 2015;46:1777–86.PubMedCrossRef Han L, Wu Q, Wang C, Hao Y, Zhao J, Zhang L, et al. Homocysteine, ischemic stroke, and coronary heart disease in hypertensive patients: a population-based, prospective cohort study. Stroke. 2015;46:1777–86.PubMedCrossRef
48.
go back to reference Wang L, Shen J, Chen CX, Chen ZB, Shen XJ, Song YJ, et al. The association between homocysteine and the different ischemic stroke subtypes: a meta-analysis. Chin J Gerontol. 2018;38:2052–5. Wang L, Shen J, Chen CX, Chen ZB, Shen XJ, Song YJ, et al. The association between homocysteine and the different ischemic stroke subtypes: a meta-analysis. Chin J Gerontol. 2018;38:2052–5.
49.
go back to reference Huang X, Li Y, Li P, Li J, Bao H, Zhang Y, et al. Association between percent decline in serum total homocysteine and risk of first stroke. Neurology. 2017;89:2101–7.PubMedCrossRef Huang X, Li Y, Li P, Li J, Bao H, Zhang Y, et al. Association between percent decline in serum total homocysteine and risk of first stroke. Neurology. 2017;89:2101–7.PubMedCrossRef
50.
go back to reference Shi Z, Guan Y, Huo YR, Liu S, Zhang M, Lu H, et al. Elevatedtotal homocysteine levels in acute ischemic stroke are associated with long-term mortality. Stroke. 2015;46(9):2419–25.PubMedPubMedCentralCrossRef Shi Z, Guan Y, Huo YR, Liu S, Zhang M, Lu H, et al. Elevatedtotal homocysteine levels in acute ischemic stroke are associated with long-term mortality. Stroke. 2015;46(9):2419–25.PubMedPubMedCentralCrossRef
51.
go back to reference Kwon HM, Lee YS, Bae HJ, Kang DW. Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke. 2014;45(3):871–3.PubMedCrossRef Kwon HM, Lee YS, Bae HJ, Kang DW. Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke. 2014;45(3):871–3.PubMedCrossRef
52.
go back to reference Kumral E, Saruhan G, Aktert D, et al. Association of hyperhomocysteinemia with stroke recurrence after initial stroke. J Stroke Cerebrovasc Dis. 2016;25(8):2047–54.PubMedCrossRef Kumral E, Saruhan G, Aktert D, et al. Association of hyperhomocysteinemia with stroke recurrence after initial stroke. J Stroke Cerebrovasc Dis. 2016;25(8):2047–54.PubMedCrossRef
53.
go back to reference Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the vitamin intervention for stroke prevention (VISP) randomized controlled trial. JAMA. 2004;291:565–75.PubMedCrossRef Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the vitamin intervention for stroke prevention (VISP) randomized controlled trial. JAMA. 2004;291:565–75.PubMedCrossRef
54.
55.
go back to reference Faraci FM, Lentz SR. Hyperhomocysteinemia, oxidative stress, and cerebral vascular dysfunction. Stroke. 2004;35:345–7.PubMedCrossRef Faraci FM, Lentz SR. Hyperhomocysteinemia, oxidative stress, and cerebral vascular dysfunction. Stroke. 2004;35:345–7.PubMedCrossRef
56.
go back to reference Antoniades C, Antonopoulos AS, Tousoulis D, Marinou K, Stefanadis C. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. Eur Heart J. 2009;30:6–15.PubMedCrossRef Antoniades C, Antonopoulos AS, Tousoulis D, Marinou K, Stefanadis C. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. Eur Heart J. 2009;30:6–15.PubMedCrossRef
57.
go back to reference Acampa M, Lazzerini PE, Martini G. Postoperative atrial fibrillation and ischemic stroke: the role of homocysteine. Eur Stroke J. 2018;3(1):92–3.PubMedCrossRef Acampa M, Lazzerini PE, Martini G. Postoperative atrial fibrillation and ischemic stroke: the role of homocysteine. Eur Stroke J. 2018;3(1):92–3.PubMedCrossRef
59.
go back to reference Wu TH, Chien KL, Lin HJ, Hsu HC, Su TC, Chen MF, et al. Total white blood cell count or neutrophil count predict ischemic stroke events among adult Taiwanese: report from a community-based cohort study. BMC Neurol. 2013;13:7.PubMedPubMedCentralCrossRef Wu TH, Chien KL, Lin HJ, Hsu HC, Su TC, Chen MF, et al. Total white blood cell count or neutrophil count predict ischemic stroke events among adult Taiwanese: report from a community-based cohort study. BMC Neurol. 2013;13:7.PubMedPubMedCentralCrossRef
60.
go back to reference Zia E, Melander O, Bjorkbacka H, Hedblad B, Engström G. Total and differential leucocyte counts in relation to incidence of stroke subtypes and mortality: a prospective cohort study. J Intern Med. 2012;272:298–304.PubMedCrossRef Zia E, Melander O, Bjorkbacka H, Hedblad B, Engström G. Total and differential leucocyte counts in relation to incidence of stroke subtypes and mortality: a prospective cohort study. J Intern Med. 2012;272:298–304.PubMedCrossRef
61.
go back to reference Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35(5):1147–52.PubMedCrossRef Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35(5):1147–52.PubMedCrossRef
62.
go back to reference Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis. 2012;222:464–7.PubMedCrossRef Kim J, Song TJ, Park JH, Lee HS, Nam CM, Nam HS, et al. Different prognostic value of white blood cell subtypes in patients with acute cerebral infarction. Atherosclerosis. 2012;222:464–7.PubMedCrossRef
63.
go back to reference Cui LL, Zhang Y, Chen ZY, Su Y-Y, Liu Y, Boltze J. Early neutrophil count relates to infarct size and fatal outcome after large hemispheric infarction. CNS Neurosci Ther. 2020;26(8):829–36.PubMedPubMedCentralCrossRef Cui LL, Zhang Y, Chen ZY, Su Y-Y, Liu Y, Boltze J. Early neutrophil count relates to infarct size and fatal outcome after large hemispheric infarction. CNS Neurosci Ther. 2020;26(8):829–36.PubMedPubMedCentralCrossRef
64.
go back to reference Zhang X, Hou X-H, Ma Y-H, Shen X-N, Cao X-P, Song J-H, et al. Association of peripheral neutrophil count with intracranial atherosclerotic stenosis. BMC Neurol. 2020;20(1):65.PubMedPubMedCentralCrossRef Zhang X, Hou X-H, Ma Y-H, Shen X-N, Cao X-P, Song J-H, et al. Association of peripheral neutrophil count with intracranial atherosclerotic stenosis. BMC Neurol. 2020;20(1):65.PubMedPubMedCentralCrossRef
65.
go back to reference Nasr N, Ruidavets JB, Arnal JF, Sie P, Larrue V. Association of neutrophil count with microembolization in patients with symptomatic carotid artery stenosis. Atherosclerosis. 2009;207:519–23.PubMedCrossRef Nasr N, Ruidavets JB, Arnal JF, Sie P, Larrue V. Association of neutrophil count with microembolization in patients with symptomatic carotid artery stenosis. Atherosclerosis. 2009;207:519–23.PubMedCrossRef
66.
go back to reference Jickling GC, Liu D, Ander BP, Stamova B, Zhan X, Sharp FR. Targeting neutrophils in ischemic stroke: translational insights from experimental studies. J Cereb Blood Flow Metab. 2015;35(6):888–901.PubMedPubMedCentralCrossRef Jickling GC, Liu D, Ander BP, Stamova B, Zhan X, Sharp FR. Targeting neutrophils in ischemic stroke: translational insights from experimental studies. J Cereb Blood Flow Metab. 2015;35(6):888–901.PubMedPubMedCentralCrossRef
67.
go back to reference Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473:317–25.PubMedCrossRef Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473:317–25.PubMedCrossRef
68.
go back to reference Carbone F, Nencioni A, Mach F, Vuilleumier N, Montecucco F. Pathophysiological role of neutrophils in acute myocardial infarction. Thromb Haemost. 2013;110(3):501–14.PubMedCrossRef Carbone F, Nencioni A, Mach F, Vuilleumier N, Montecucco F. Pathophysiological role of neutrophils in acute myocardial infarction. Thromb Haemost. 2013;110(3):501–14.PubMedCrossRef
69.
go back to reference Arboix A, Estevez S, Rouco R, Oliveres M, García-Eroles L, Massons J. Clinical characteristics of acute lacunar stroke in young adults. Expert Rev Neurother. 2015;15(7):825–31.PubMedCrossRef Arboix A, Estevez S, Rouco R, Oliveres M, García-Eroles L, Massons J. Clinical characteristics of acute lacunar stroke in young adults. Expert Rev Neurother. 2015;15(7):825–31.PubMedCrossRef
70.
go back to reference Di Raimondo D, Tuttolomondo A, Buttà C, Casuccio A, Giarrusso L, Miceli G, et al. Metabolic and anti-inflammatory effects of a home-based programme of aerobic physical exercise. Int J Clin Pract. 2013;67(12):1247–53.PubMedCrossRef Di Raimondo D, Tuttolomondo A, Buttà C, Casuccio A, Giarrusso L, Miceli G, et al. Metabolic and anti-inflammatory effects of a home-based programme of aerobic physical exercise. Int J Clin Pract. 2013;67(12):1247–53.PubMedCrossRef
71.
go back to reference Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, Licata G. Risk factors profile and clinical outcome of ischemic stroke patients admitted in a Department of Internal Medicine and classified by TOAST classification. Int Angiol. 2006;25(3):261–7.PubMed Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, Licata G. Risk factors profile and clinical outcome of ischemic stroke patients admitted in a Department of Internal Medicine and classified by TOAST classification. Int Angiol. 2006;25(3):261–7.PubMed
72.
go back to reference Arboix A, Alió J. Acute cardioembolic stroke: an update. Expert Rev Cardiovasc Ther. 2011;9(3):367–79.PubMedCrossRef Arboix A, Alió J. Acute cardioembolic stroke: an update. Expert Rev Cardiovasc Ther. 2011;9(3):367–79.PubMedCrossRef
Metadata
Title
Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study
Authors
Nan Zhang
Lin Zhang
Qiu Wang
Jingwei Zhao
Jia Liu
Guang Wang
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Stroke
Published in
BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-020-02005-7

Other articles of this Issue 1/2020

BMC Neurology 1/2020 Go to the issue