Recent studies have shown that women under 45 years of age are more likely to suffer a stroke than men.- Most strokes are caused by so-called “traditional” vascular risk factors such as hypertension, hyperlipidemia and diabetes. However, women have a lower frequency of these risk factors than men. A recent study by Leppert and colleagues examined what other non-traditional risk factors exist for strokes in addition to those previously known.

A total of 2618 patients with strokes (52% women; 73.3% ischemic strokes) and 7827 controls were examined. All traditional risk factors were more common in cases than in controls. The most common traditional risk factors were hypertension (44.3%), hyperlipidemia (33%) and tobacco use (28.8%) in men and hypertension (41.6%), tobacco use (32.8%) and hyperlipidemia (28.9%) %) in women. The most common non-traditional risk factors were migraine (24.2%), renal failure (15.5%) and thrombophilia (12.4%) in men and migraine (43.6%), thrombophilia (13.5%) and malignant Diseases (11.4%) in women. Women with stroke were less likely to become pregnant but were more likely to use oral contraceptives than controls. Migraines have been linked to 20.1% and 34.5% of strokes in men and women.

The study shows that non-traditional risk factors were just as important as traditional risk factors in the development of stroke in both men and women. Hypertension was the most important traditional risk factor, increasing in importance with age in both men and women, accounting for 27.8% and 26.7% of strokes in men and women aged 45 to 55 years, respectively. In contrast, migraine was the most important non-traditional risk factor, the proportion of which decreased with age, causing 20.1% and 34.5% of strokes in men and women under 35 years of age, respectively. Non-traditional risk factors were found to be equally important for the development of stroke in young men and women. The results underscore the importance of considering non-traditional risk factors for the cause of stroke in young adults. Migraine was found to be the most important non-traditional risk factor in young adults in this study. This study shows for the first time the contribution of migraine to the overall attributable risk of stroke in young adults, which was half the population attributable risk in adults under 35 years of age.

There are many data-backed hypotheses explaining the association between migraine and stroke (see figure), from (1) hypercoagulability due to increased procoagulant substances exacerbated by smoking or exogenous estrogen, to (2) hypoperfusion caused by cortical spreading depression, (3) endothelial dysfunction caused by accelerated atherosclerosis, (4) embolism caused by right-to-left shunts, (5) genetic associations that cause both migraines and strokes, and (6 ) Treatments used for migraine, including nonsteroidal anti-inflammatory drugs, triptans, and ergotamine. It is still unclear how much each individual mechanism contributes to the overall risk of stroke in migraine patients or whether migraine is a modifiable risk factor for stroke. To date, the only intervention to reduce the risk of stroke in migraine patients is the recommendation to avoid combined hormonal contraceptives in women with migraine with aura. However, migraine and stroke may share similar clinical features in young adults, increasing the potential for misdiagnosis and complicating research.

The bottom line is that non-traditional risk factors are as important as traditional risk factors in the development of stroke in both young men and women. In adults ages 18 to 34, more strokes were associated with nontraditional than traditional risk factors. Overall, nontraditional risk factors are as strongly associated with the development of stroke in young adults ages 18 to 44 as traditional risk factors. Further research is needed to better understand how migraine contributes to stroke risk in young adults and to develop primary and secondary prevention interventions in migraine patients.

Source : Leppert MH, Poisson SN, Scarbro S, Suresh K, Lisabeth LD, Putaala J, Schwamm LH, Daugherty SL, Bradley CJ, Burke JF, Ho PM. Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study. Circ Cardiovasc Qual Outcomes. 2024 Mar 26:e010307. doi: 10.1161/CIRCOUTCOMES.123.010307. Epub ahead of print. PMID: 38529631