Objective: To study the long-term prevalence of small vessel disease after young stroke and to compare this to healthy controls.
Methods: This prospective cohort study comprises 337 patients with an ischemic stroke or TIA, aged 18-50 years without a history of TIA or stroke. In addition 90 age and sex matched controls were included. At follow-up lacunes, microbleeds and white matter hyperintensitie (WMH) volume were assessed using MRI. To investigate the relation between riks factors and small vessel disease, logistic and linear regression were used.
Results: After mean follow-up of 9.9 (SD 8.1) years, 337 patients were included (227 with an ischemic stroke and 110 with a TIA). Mean age for patients was 49.8 (SD 10.3) years and 45.4% were men, for controls mean age was 49.4 (SD 11.9) and 45.6% were men. Compared with controls, patients more often had at least one lacune (24.0% versus 4.5%, p<0.0001). In addition, they had a higher WMH-volume (median 1.5 ml (IQR 0.5-3.7) versus 0.4 ml (IQR 0.0-1.0), p<0.001). Compared with controls, patients had the same volume of WMH on average 10-20 years earlier. In the patient group, age at stroke (beta=0.03 (95%CI 0.02-0.04) hypertension (beta=0.22, 95%CI 0.04-0.39) and smoking (beta=0.18, 95%CI 0.01-0.34) at baseline were associated with WMH-volume.
Conclusions: Patients with a young stroke have a higher burden of small vessel disease than controls adjusted for confounders. Cerebral aging seems accelerated by 10-20 years in these patients, which may suggest an increased vulnerability to vascular risk factors.