Traditional risk factors and ischemic stroke in young adults: the Baltimore-Washington Cooperative Young Stroke Study
J. Rohr, S. Kittner, B. Feeser, J. R. Hebel, M. G. Whyte, A. Weinstein, N. Kanarak, D. Buchholz, C. Earley, C. Johnson, R. Macko, T. Price, M. Sloan, B. Stern, R. Wityk, M. Wozniak and R. Sherwin
Department of Neurology, University of Maryland Medical School, Baltimore 21201-1559, USA.
OBJECTIVE: To determine the association of hypertension, diabetes, and
cigarette smoking with incidence of ischemic stroke in young adults.
DESIGN: Case-control study. SETTING: Population-based sample of cases and
controls. SUBJECTS: The study included 296 cases of incident ischemic
stroke among black and white adults aged 18 to 44 years in central Maryland
counties from the Baltimore-Washington Cooperative Young Stroke Study and
1220 black and white adults aged 18 to 44 years from the Maryland
Behavioral Risk Factor Survey, a telephone survey of a random sample of the
same region, to serve as controls. MAIN OUTCOME MEASURES: Logistic
regression models were developed to determine the age-adjusted odds ratios
for each risk factor. Population-attributable risk percent were computed
based on the odds ratios and prevalence of each risk factor. RESULTS: The
age-adjusted odds ratios (95% confidence intervals) for white men (WM),
white women (WW), black men (BM), and black women (BW) were as follows:
current cigarette smoking: WM, 2.0 (1.1-3.8), WW, 2.1 (1.1-4.3), BM, 3.3
(1.6-6.6), and BW, 2.2 (1.3-3.9); history of diabetes mellitus: WM, 22.9
(5.8-89.6), WW, 6.2 (1.9-20.2), BM, 4.2 (0.8-21.9), and BW, 3.3 (1.4-7.7);
and history of hypertension: WM, 1.6 (0.7-3.2), WW, 2.5 (1.1-5.9), BM, 3.8
(1.8-7.9), and BW, 4.2 (2.4-7.5). The population-attributable risk percent
(95% confidence intervals) were as follows: current cigarette smoking: WM,
22.6 (3.1-38.2), WW, 17.2 (4.0-34.0), BM, 40.5 (23.1-54.0), and BW, 29.1
(13.5-41.9); history of diabetes mellitus: WM, 19.0 (8.2-28.5), WW, 15.8
(3.8-26.3), BM, 13.2 (5.3-20.4), and BW, 22.1 (12.5-30.7); and history of
hypertension: WM, 21.7 (6.2-34.6), WW, 21.3 (5.4-34.5), BM, 53.5
(39.0-64.4), and BW, 50.5 (37.1-61.1). CONCLUSIONS: Hypertension, diabetes
mellitus, and current cigarette smoking are important risk factors in a
biracial young adult population. Cigarette smoking and hypertension, the 2
most modifiable risk factors, were particularly important risk factors in
young blacks.
