THURSDAY, April 17, 2025 (HealthDay News) — Traditional risk factors contribute to young-onset cryptogenic ischemic stroke (CIS) without patent foramen ovale (PFO), while nontraditional risk factors seem more important for CIS with PFO, according to a study published online April 17 in Stroke.

Jukka Putaala, M.D., from Helsinki University Hospital and the University of Helsinki, and colleagues enrolled patients aged 18 to 49 years with recent CIS and frequency-matched stroke-free controls of the same age and sex from 19 European sites to examine the burden and associations of risk factors with young-onset CIS (523 patients and 523 controls). The association of risk factors (12 traditional, 10 nontraditional, and five female sex-specific) with CIS, stratified by PFO, was assessed.

The researchers found that each additional traditional, nontraditional, and female sex-specific risk factor increased CIS risk in patients with CIS without PFO (odds ratios, 1.417, 1.702, and 1.700, respectively). Each traditional risk factor increased the risk in patients with CIS with PFO (odds ratio, 1.185); when fully adjusted, only nontraditional risk factors remained significant (odds ratio, 2.656). For CIS without PFO, population-attributable risks were 64.7, 26.5, and 18.9 percent for traditional, nontraditional, and female sex-specific risk factors, respectively. The corresponding population-attributable risks for CIS with PFO were 33.8, 49.4, and 21.8 percent. The most significant contributor was migraine with aura, with population-attributable risks of 45.8 and 22.7 percent for CIS with PFO and CIS without PFO, respectively, and with a stronger impact seen for women.

“The prominent role of behavioral factors and the strong association with migraine with aura underscore the necessity for a thorough and tailored approach to risk factor assessment and prevention strategies in young adults,” the authors write.

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