Most people only think about their cardiovascular health as they age, but a recent study revealed that strokes, a type of cardiovascular disease, are on the rise among young people, and have nearly doubled over the past three decades.
“Stroke is a devastating disease at any age, but it is especially devastating when it strikes young people,” said Dr. David Robinson, lead researcher on the study published in the medical journal Neurology.
The researchers found that the rate of strokes among young people rose from 33.9 cases per 100,000 people between 1993 and 1994 to 62.2 cases per 100,000 people in 2020. The study also recorded a slight increase in the number of stroke survivors, indicating that more young people may be living with their long-term effects.
Disability resulting from a stroke may make it difficult to engage in daily activities, such as working or caring for young children, explained Robinson, an assistant professor of clinical neurology and rehabilitation medicine at the University of Cincinnati College of Medicine.
He added that realizing the possibility of stroke occurring at an early age, and knowing that there are ways to prevent it, is important.
Experts advise young people to know how to protect cardiovascular health and reduce the risk of stroke.
Ischemic strokes are behind the increase
The study looked at strokes among people ages 20 to 54 in the greater Cincinnati area and northern Kentucky. Between 1993 and 2020, 2,076 first cases of stroke were recorded, including 738 cases among black people (35.6%) and 1,030 cases among women (49.6%).
The study indicated that ischemic strokes, the most common type, were the main reason behind this increase, and occur when blood flow to part of the brain is cut off.
The researchers also noted an increase in stroke risk factors over the 27-year study period, with rates of high blood pressure rising from 47% to 60%, diabetes from 19% to 26%, atrial fibrillation from 1% to 6%, and substance use from 5% to 40%, largely due to increased marijuana use.
But because similar data are not available for people who have not had a stroke, researchers cannot determine whether these changes in risk factors explain the higher rates of stroke.
Although these trends are also observed among older people, stroke rates among them have not increased.
“That may be part of the explanation, but it doesn't explain the whole thing,” Robinson said, adding that high rates of obesity and cholesterol, along with lack of physical activity, may also increase the risk of stroke.
"I think there are multiple factors coming together, not just one factor," Robinson explained. "To reduce this risk, we should start with what we know best, which is reducing cardiovascular risk factors."
Robinson pointed to the American Heart Association's "Essential 8," a list that helps reduce risk factors, including eating a healthy diet, being physically active, avoiding tobacco, getting good sleep, and managing weight, cholesterol, blood pressure and blood sugar.
He added that it is important for young people to have a primary care doctor who monitors their condition and checks these indicators regularly, pointing out that it is important to start paying attention to cardiovascular health at an early age, because discovering risk factors early gives us a greater opportunity to intervene and reduce complications.
For his part, Dr. Christopher Anderson, head of the Stroke Department in the Department of Neurology at Mass General Brigham in Boston, USA, said that the results were not surprising, but rather are in line with a trend indicated by previous studies. Anderson was not involved in the new study.
Anderson, who is also an associate professor of neurology at Harvard Medical School, pointed out that the importance of the study lies in the fact that the significant increase in stroke rates was observed in a group of people with racial, socioeconomic characteristics, and educational level that are largely representative of the population of the United States, which makes it likely that the results can be generalized to the country.
Dr. Michelle Lippert, a neurologist who specializes in vascular diseases at Tufts Medical Center, said the findings didn't surprise her either, stressing the importance of studies collecting data on strokes among young people. Lippert was not involved in the study.
“The actual numbers are still relatively low, but we should start investing time and money into understanding this issue, because it's not going away and it doesn't seem to be getting better,” explained Lippert, who is also an associate professor of neurology at Tufts University School of Medicine.
She added that strokes are still relatively rare, so there is no need to panic among young people. But she stressed the importance of conducting annual health examinations with a doctor to detect those most at risk, in addition to doctors being aware of the high rates of strokes among young people and working to discover risk factors related to blood vessels and treat them early.
Lippert noted that young women, who have strokes at a higher rate than young men, should monitor their blood pressure closely during pregnancy and after childbirth, and consult a doctor if they experience migraines accompanied by visual changes while using estrogen-containing birth control pills.
“Young people should realize that high stress, unhealthy diet, lack of sleep, and lack of physical activity, even in early and middle life, have a real and measurable impact on the risk of diseases such as stroke,” Anderson said in an email. “Unfortunately, it does not take until retirement age for these cumulative risks to have a significant impact on a person’s health.”
