ABSTRACT

Introduction:
Cryptogenic ischemic stroke (CIS) is responsible for the increase in young ischemic strokes. We investigated non-alcoholic caffeinated beverages as a trigger for young CIS, in a large multi-center, case-control study.

Methods:
In Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725), patients 18-49 years old suffering first ever CIS were recruited within 2 weeks of symptom onset. A structured questionnaire obtained information on coffee, tea, and cola consumption in the last 12 months, usual daily consumption, consumption 24 h preceding stroke and timing of the last consumption prior to stroke. Case-crossover analysis was performed using the Mantel-Haenszel method.

Results:
598 CIS patients (54.7% male, mean age 39.4 [standard deviation 8.2]) were analyzed. Case-crossover analysis found association with coffee consumption in the 1-h (relative risk [RR] 1.73, 95% confidence interval [CI] 1.06-2.83) and 2-h (RR 2.15, 95%CI 1.40-3.29) hazard periods, tea consumption in the 1-h (RR 3.93, 95%CI 1.04-14.95) and 2- hour (RR 4.89, 95%CI 1.92-12.50) hazard periods and cola consumption (RR 3.70, 95%CI 1.18-11.62) in the 2-h hazard period. Sub-group analysis in the 2-h hazard period found coffee consumption was associated in both sexes and age groups, high-risk patent foramen ovale (PFO), mild/moderate stress and both low-/high-risk factor burden. Tea consumption was associated in both sexes and age groups and those without PFO.

Conclusion:
Coffee, tea, and cola consumption as potential trigger factors were associated with young CIS patients within the 2-h hazard period, with coffee and tea maintaining association in several sub-groups.

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