Abstract: Objective To investigate the factors that contribute to the occurrence of acute ischemic stroke(AIS)in individuals aged 18 to 50 years in real-world settings. Methods This study employed data from the Cheeloo Lifespan Electronic Health Research Data-library(Cheeloo LEAD), housed within the National Health and Medical Big Data Research Institute of Shandong Province. The AIS group comprised individuals aged between 18 and 50 years who had been newly diagnosed with AIS during 2012-2022 and who had complete physical examination data. The non AIS group consisted of individuals without AIS, matched at a ratio of 1∶2 by age and sex. Multivariate Logistic regression analyses were conducted to identify factors associated with the occurrence of AIS. A nomogram was constructed to illustrate the contribution of each factor, and the models performance was evaluated using the area under the receiver operating characteristic curve(AUC). Results A total of 17 independent risk factors for AIS were identified, including female sex, smoking, elevated body mass index(BMI), hypertension, diabetes mellitus, coronary atherosclerotic heart disease, hyperlipidemia, sleep disorders, anxiety, chronic obstructive pulmonary disease, asthma, hyperhomocysteinemia, patent foramen ovale, valvular heart disease, migraine, rheumatic diseases, and intracerebral hemorrhage. A nomogram model was developed based on these risk factors, achieving an AUC of 0.803. Conclusion Among people aged 18 to 50, the occurrence of AIS is significantly associated with multi-system diseases and lifestyle factors, including metabolic diseases(such as hypertension and diabetes), cardiovascular diseases, mental and neurological disorders(such as sleep disorders and anxiety), and chronic inflammatory diseases, and so on.

Key words: Acute ischemic stroke, Influencing factors, Real-world study, Nomogram, Prediction model