Stroke Rates Double Among Younger Adults
Traditionally associated with older adults, it is becoming more common among younger people, with a recent study finding that the rate among adults aged 20 to 54 nearly doubled over less than three decades.
Researchers analyzed data from residents of the Greater Cincinnati and Northern Kentucky area in the United States between 1993 and 2020, identifying 2,076 first-time strokes among adults in the age group.
According to the study, published in the journal Neurology by the American Academy of Neurology, the annual stroke incidence increased from 33.9 cases per 100,000 people in 1993 and 1994 to 62.2 cases per 100,000 in 2020.
The increase was primarily driven by ischemic strokes, the most common type of stroke, which occurs when a blood clot or another blockage prevents blood from reaching part of the brain.
The incidence of ischemic stroke increased from 23.8 cases per 100,000 people per year to 47.3 cases during the study period. Researchers did not observe a comparable increase in strokes caused by bleeding in or around the brain.
Emily Fischer, a co-researcher from the University of Cincinnati, said stroke had traditionally been viewed as a disease affecting older people, but the findings indicate that its incidence is increasing among younger adults even as survival rates have improved.
A stroke at a younger age can potentially leave people living with its effects for many years, including difficulties affecting movement, speech and memory. Such complications can also affect employment, childcare responsibilities and independence in daily life.
RISK FACTORS ON THE RISE
The study found increases in several health conditions among younger adults who experienced strokes.
The proportion of patients with high blood pressure increased from approximately 47% to 60%, while the prevalence of diabetes rose from 19% to 26%. The proportion with atrial fibrillation, an irregular heart rhythm associated with stroke risk, increased from about 1% to 6%.
The percentage of people recorded as using drugs also increased from less than 5% in 1993 to approximately 40% in 2020, with researchers noting that much of the increase was associated with greater marijuana use.
The researchers stressed that the study does not establish that these factors caused the increase in stroke rates, because comparable data were not available for people of the same age who did not experience strokes.
The researchers said the reasons for the increase are likely complex, with multiple factors potentially overlapping. These include increasing rates of obesity, high cholesterol, diabetes and high blood pressure, as well as physical inactivity, smoking and sleep disorders.
BETTER SURVIVAL, LONGER-TERM BURDEN
The study also found a modest improvement in short-term survival following stroke.
After adjustments for differences in age, gender and race, the 30-day mortality rate fell from 11.7% at the beginning of the study period to 9.4% in 2020.
Researchers noted, however, that improved survival can also mean that more younger stroke survivors may live for years or decades with disabilities or other complications resulting from the condition.
The findings reinforce the importance of addressing cardiovascular health earlier in life rather than waiting until middle or old age.
The American Heart Association recommends focusing on eight key areas of cardiovascular health, including healthy eating, physical activity, avoiding smoking and nicotine, getting sufficient sleep, maintaining a healthy weight, and managing cholesterol, blood sugar and blood pressure.
Experts also emphasize the importance of regular health checks because conditions such as high blood pressure, high cholesterol and diabetes can develop for years without obvious symptoms.
WOMEN'S HEALTH AND STROKE RISK
Previous research and stroke-prevention guidelines have also identified several factors that require particular attention among women.
These include high blood pressure during pregnancy and after childbirth, which can be associated with future cardiovascular risks.
Stroke risk factors should also be considered among women who experience migraines accompanied by visual disturbances when evaluating the use of estrogen-containing contraceptives.
The American Heart Association’s guidance emphasizes the importance of incorporating pregnancy-related risk factors and women's health into stroke prevention.
Despite the significant increase reported in the study, researchers noted that stroke remains less common among younger adults than among older people. The findings therefore do not suggest that younger adults should panic, but they do challenge the assumption that youth alone provides protection from stroke.
Researchers said monitoring blood pressure, blood sugar and cholesterol, remaining physically active, maintaining healthy sleep habits and following a balanced diet can all form part of cardiovascular health at a younger age.
Researchers stressed that further, larger studies are needed to determine the precise reasons behind the rising incidence of stroke among younger adults.
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