What are the causes of stroke in young Asian individuals?

From the Guidelines

Strokes in young Asians are primarily caused by hypertension, which is the single most important reversible risk factor for stroke, as emphasized by the Asia-Pacific Consensus Conference on Stroke Prevention in Hypertensive Patients 1.

Key Risk Factors

• Hypertension: The most significant reversible risk factor for stroke, with a high prevalence in Asian populations 1
• Traditional risk factors: Diabetes, smoking, and dyslipidemia also play significant roles in stroke risk
• Unique genetic factors: Inherited conditions like CADASIL and specific genetic variants more common in Asian populations contribute to stroke risk
• Intracranial arterial stenosis: More frequent in Asians than in Western populations, increasing stroke risk
• Lifestyle factors: High-sodium diets, increasing obesity rates, and high smoking prevalence among young Asian males further elevate risk
• Non-atherosclerotic vasculopathies: Moyamoya disease and Takayasu arteritis occur more frequently in Asian populations
• Illicit drug use: Methamphetamine use is a concerning cause of stroke in young Asians in some regions

Prevention and Management

• Early identification and management of risk factors are essential for prevention in high-risk individuals
• Blood pressure control, smoking cessation, healthy diet, regular exercise, and appropriate medication when indicated are crucial for reducing stroke risk
• The management of cholesterol to reduce the burden of stroke in Asia is also important, as highlighted by the Working Group on Stroke and Lipids Management in Asia Consensus Panel 1

Prioritizing Morbidity, Mortality, and Quality of Life

The most recent and highest quality study, although not directly addressing the question, emphasizes the importance of hypertension management in reducing stroke risk 1, which is a critical aspect of preventing strokes in young Asians and improving their morbidity, mortality, and quality of life.

From the Research

Causes of Stroke in Young Asians

• The most common causes of ischemic stroke in young Asians include small-vessel disease, undetermined etiology, and embolic stroke of undetermined source (ESUS) 2
• Traditional risk factors for stroke, such as hypertension, diabetes, hypercholesterolemia, and smoking, are prevalent in East Asian countries and contribute to the burden of stroke in this region 3
• In young Asian adults, the most common risk factors for ischemic stroke include hypertension, dyslipidemia, and current smoking 4
• Other causes of ischemic stroke in young Asians include intracranial arterial dissection, cardioembolism, and cerebral venous thrombosis 4, 5

Risk Factors for Stroke in Young Asians

• Modifiable risk factors, such as hypertension, diabetes, and smoking, are common in young Asian adults with ischemic stroke 2, 4
• The prevalence of these risk factors increases with age, emphasizing the importance of lifestyle improvement to prevent stroke in young people 4
• Other risk factors, such as pregnancy and valvular heart disease, are also significant in young Asian women with ischemic stroke 5

Subtypes of Stroke in Young Asians

• The most common subtypes of ischemic stroke in young Asians include small-vessel disease, large-vessel thrombosis, and cardioembolism 2, 5
• Cerebral venous thrombosis is also a significant subtype of ischemic stroke in young Asian women 5
• The subtype of stroke can vary depending on the age and sex of the patient, as well as other factors such as lifestyle and medical history 2, 4, 5