Stroke incidence has doubled in people under 55 in high-income countries, even as it falls in older age groups. This matters because the reasons for this rise remain poorly understood, and existing prevention tools were developed for older populations. The research addresses four gaps: the true scale and long-term consequences of young stroke, the mechanistic drivers behind the increase, whether current risk prediction tools work for younger people, and the need for better data and biological samples to study the problem. If successful, the work could change how stroke prevention is targeted at younger ages. It may identify new risk factors and early-disease markers—such as blood tests or imaging findings—that improve risk stratification. The findings could inform national policy on stroke service provision and prevention strategies, potentially reducing the burden of vascular events in a population not traditionally considered at high risk. The data and biosamples collected will also be made available for future collaborative research.
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Research Question Why are young strokes increasing? Is the trend continuing? What are the potential long-term consequences to individuals and to society? How can we improve stroke prevention at younger ages? Background We and others have shown that contrary to a decrease in stroke incidence at older ages in high-income counties, there is a doubling in incidence of young stroke (age Aims and Objectives I aim to better understand the causes and routes to prevent stroke at younger ages. There are four aims: Determine the burden and impact of the increase in young stroke, including the severity, aetiological subtypes, population most affected, short-term outcomes, and long-term prognosis; Better understand the key mechanistic drivers for the increase in young stroke, including the associations with traditional risk factors, emerging stroke risk factors, under-recognised and novel aetiologies; Improve risk stratification and prediction for young stroke; and Make the new data and biosamples available for collaboration. Methods To achieve these aims I will: Analyse 10&20-year follow-up data from a population-based study (Oxford Vascular Study - OXVASC-YSS) and collate individual participant-level data from similar studies in other countries (International Stroke Incidence Studies Data Pooling Project - ISIS-DPP-YSS); Initiate the main phase (n=1000 patients) of a deeply-phenotyped cohort study (Thames Valley Young Stroke Study - TV-YSS) with stroke-free controls (n=250); Recruit a national study through the NIHR Clinical Research Network and collect data on ~5000 young patients (National Young Stroke Study - NYSS), and compare with participants of the Health Survey for England. Timelines Aim 1: ISIS-DPP-YSS (Year 1&2) OXVASC-YSS (Year 1&2 for 10-year outcome; Year 5 for 20-year outcome) Aim 2: TV-YSS (Year 1-5 for recruitment with 150-200 patients/year and annual follow-up; Year 4-5 analysis) NYSS (Year 1-5 for recruitment with 4 patients/day; Year 4-5 analysis) Aim 3: OXVASC-YSS (Year 1 to assess the utility of existing tools) TV-YSS (Year 4 to assess the predictive value of blood/imaging/physiological markers) Aim 4: Data sharing from Year 5 onwards Anticipated impact Findings from this work will inform primary and secondary prevention of stroke at younger ages and ultimately help to reduce the burden of vascular events. Specifically, By characterising and closely monitoring the nature, burden, and impact of the increasing incidence of stroke at younger ages, the study findings will inform more targeted prevention and offer guidance to policymakers when formulating national policy and service provision; By identifying the main mechanistic drivers, the study will shed light on more effective prevention and management strategies; By determining the predictive value of early-disease blood/imaging/physiological markers, the results will improve risk stratification at younger ages, with the potential to lead to formal testing of the utility of these markers to guide primary prevention after the completion of this award; By making the new data and biosamples collected available, this study will build rich resources for future collaborations.
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