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Apr 19 2025
4A new study has shed light on why strokes of unknown origin—also known as cryptogenic strokes—are increasingly affecting adults under the age of 50. Researchers found that nontraditional risk factors, including migraines with aura, liver disease, and cancer, play a more significant role than traditional risk factors like high blood pressure in younger adults, particularly those born with a heart condition called patent foramen ovale (PFO).
Published in Stroke, a journal of the American Stroke Association, the study analyzed data from over 1,000 European adults aged 18 to 49, with a median age of 41. Half of the participants had previously experienced a cryptogenic ischemic stroke, while the other half had no history of stroke. The research team examined the impact of 12 traditional risk factors, 10 nontraditional risk factors, and 5 female-specific risk factors, such as gestational diabetes and pregnancy-related complications.
The results indicated that among participants with PFO—a small opening between the upper chambers of the heart—nontraditional risk factors were far more influential in stroke risk. In contrast, those without PFO were more affected by traditional risk factors like high blood pressure and cholesterol. Notably, each nontraditional risk factor increased stroke risk by 70% in individuals without PFO, compared to a 41% increase from each traditional factor. For women, risk factors unique to their sex raised stroke risk by 70% regardless of other variables.
In participants with PFO, traditional risk factors raised stroke risk by only 18%. However, nontraditional factors more than doubled the likelihood of having an ischemic stroke after accounting for demographic characteristics like age, sex, and education level. Of particular concern was migraine with aura, which emerged as the most significant nontraditional risk factor. It accounted for 46% of strokes in those with PFO and 23% in those without.
“Up to half of all ischemic strokes in younger adults have no identifiable cause and are more common in women,” said lead author Dr. Jukka Putaala, head of the stroke unit at the Neurocenter, Helsinki University Hospital in Finland. “To prevent future strokes, we need to routinely assess both traditional and nontraditional risk factors in young people, especially after a stroke has occurred.”
Population-level analysis revealed that in stroke cases without PFO, traditional risk factors were responsible for about 65% of cases, while nontraditional and female-specific factors accounted for 27% and 19% respectively. In contrast, for strokes involving a PFO, nontraditional factors contributed to 49% of cases, traditional risk factors 34%, and female-specific factors 22%.
Dr. Tracy E. Madsen, an emergency medicine specialist and member of the American Heart Association’s Women’s Health Science Committee, highlighted the importance of the study’s sex-based data. “We know stroke risks vary between men and women and change with age. Recognizing that migraine with aura and pregnancy-related issues are key risks for young women can help reshape how we screen and educate patients,” she said.
The findings come from the SECRETO study (Searching for Explanations for Cryptogenic Stroke in the Young), conducted between 2013 and 2022 across 19 centers in 13 European countries. While the study offers valuable insights, it is observational and based on self-reported data, which limits its ability to prove direct cause and effect. Moreover, the sample predominantly consisted of white European adults, potentially limiting broader applicability.
Still, the research emphasizes a shift in understanding stroke risk in younger populations and underscores the need for more individualized approaches to prevention and care.
Source: https://www.sciencedaily.com/releases/2025/04/250417145247.html
This is non-financial/medical advice and made using AI so could be wrong.
