Impact of cardiovascular risk factors and anti-hypertensive drug for the incidence of ischemic and hemorrhagic stroke in young adults

Abstract

Background Young adults stroke incidence is showing an increased trend globally, and its social and economic loss are drawing attention. The effect of cardiovascular risk factors and anti-hypertensive medication on stroke incidence in young health adults was analyzed using a large-scale population medical use database in Korea. Methods Five million young healthy Korean adults without comorbidities who underwent regular health check-up exam was included in the cohort. They were categorized to four groups according to blood pressure (normal, elevated BP, stage 1 HTN, and stage 2 HTN) and follow-up for mean 13.9 years. The primary outcome was the incidence of ischemic and hemorrhagic stroke by tracking the medical use data of first ever ICD-10 codes. Subgroup analysis of stage 2 HTN group categorized to ‘no HTN medication’ and ‘HTN medication group’ according to prescription ratio (<25%; no HTN medication, ≥25%; HTN medication group) of anti-hypertensive drug during follow-up period. Results Stage 2 HTN elevated the risk of ischemic and hemorrhagic stroke about 2.18 and 3.07 times (Model 3 multivariate cox proportional hazard regression), respectively, compared to normal BP group. Diabetes mellitus was the dominant risk factor for ischemic stroke, followed by stage 2 HTN, current smoker, obesity, and hyperlipidemia. Stage 2 HTN was the dominant risk factor for hemorrhagic stroke, followed by current smoker, high alcohol intake, and obesity. In stage 2 HTN subgroup analysis, anti-hypertensive medication decreased the incidence of ischemic stroke to 60% (Model 3) and hemorrhagic stroke to 68%, respectively. Conclusions Traditional cardiovascular risk factors contributed to the incidence of ischemic and hemorrhagic stroke in young adults. Anti-hypertensive medication of stage 2 HTN population decreased the incidence of both ischemic and hemorrhagic stroke remarkably over 50%. Education and proper guidance for high blood pressure for young adult population may lead to a significant decrease of stroke in future.