Metabolic predictors of ischemic stroke in young adults

Introduction. Ischemic stroke (IS) has a tendency towards younger age of onset among working-age adults, with an increasing role of obesity in IS development. New prognostic markers affecting stroke severity and early outcomes are being sought. Aim: to investigate etiology and risk factors of cryptogenic IS in working-age patients (18–50 years) and evaluate the significance of metabolic markers of obesity and hemostasis in predicting immediate disease outcomes. Materials and methods. We retrospectively analyzed 343 medical records of acute stroke patients aged 18–50 years using clinical, laboratory, and imaging findings and calculated risk levels. Results. Obesity was observed in more than half (51.3%) of the patients. Early atherosclerotic changes in the vessel wall were detected in 62.26% of the cases. Worse immediate stroke outcomes were associated with all obesity parameters: body mass index (r = 0.48), waist circumference (WC) (r = 0.43), waist-to-hip ratio (WHR) (r = 0.52), levels of glucose (r = 0.47), C-reactive protein (r = 0.34), hematocrit (r = 0.41), high-density lipoproteins (r = –0.32), von Willebrand factor (r = 0.58), fibrinogen (r = 0.66), FVIII (r = 0.50), D-dimer (r = 0.50), and ADP-induced platelet aggregation (r = 0.41). Stroke severity was found to correlate with levels of triglycerides (r = 0.57), low-density lipoproteins (r = 0.35), von Willebrand factor (r = 0.55), fibrinogen (r = 0.46), coagulation factor VIII (r = 0.63), D-dimer (r = 0.39), antithrombin III (r = 0.39), and WHR (r = 0.53). Receiver operating characteristic curves revealed triglyceride-glucose index to be a predictor of worse early outcome (area under the curve, 0.66; threshold, 4.7), including in terms of WC (0.68 and 497.6, respectively) or stroke severity (0.63 and 4.7, respectively). Conclusion. IS in young adults is accompanied by impaired metabolism, affecting the disease outcome. Indices including glucose, triglycerides, and the obesity status can play a role in predicting the stroke severity in young adults, among others.