Stroke is becoming more common among younger adults. What experts want them to know

By Taylor Nicioli, CNN

(CNN) — Most people don’t worry about their cardiovascular health until they get older. But strokes, one type of cardiovascular disease, in young adults are steadily on the rise — and have nearly doubled in the last three decades, according to a new study.

“Stroke is a very devastating disease at any age. It is particularly devastating when it happens to younger people,” said Dr. David Robinson, senior author of the study published Wednesday in the medical journal Neurology.

Researchers found that the rate of strokes among younger adults increased from 33.9 cases per 100,000 people in 1993 to 1994 to 62.2 cases per 100,000 people in 2020. The study also reported a slight increase in people surviving strokes, suggesting that more younger adults may be living with the long-term effects of a stroke.

“The disability that can result from stroke can make it much harder to do all the things you need to do to live your life,” such as working or keeping up with young children, said Robinson, an assistant professor of clinical neurology and rehabilitation medicine at the University of Cincinnati College of Medicine.

“Knowing that this is possible — that stroke doesn’t just happen in older people, that it can happen in younger people — and that there are ways in which we can try our best to prevent this is really an important takeaway,” Robinson said.

Here’s what experts recommend for young adults to know to help protect cardiovascular health and reduce the risk of a stroke.

Ischemic strokes are primarily behind rise

The study looked at strokes among adults ages 20 to 54 in the greater Cincinnati and northern Kentucky region. From 1993 through 2020, there were 2,076 first-ever strokes among the population, with 738 cases occurring in Black individuals (35.6%) and 1,030 cases occurring in female individuals (49.6%).

Ischemic strokes — the most common type of stroke — primarily drove the increase, according to the study. These occur when blood flow to part of the brain is blocked.

The researchers also noted a rise in stroke risk factors across the 27-year period, with hypertension increasing from 47% to 60%, diabetes from 19% to 26%, atrial fibrillation from 1% to 6% and substance use from 5% to 40%, largely attributable to increased marijuana use.

However, since there is no comparable data from people without stroke, the study authors cannot determine if these trends in risk factors explain the increase in stroke rates.

Furthermore, while these trends were also observed in older people, the numbers for strokes in older adults has not risen. “It might be part of the story,” Robinson said, “but I don’t think it’s the entire story here.”

The rise of health issues such as obesity and high cholesterol can also contribute to the likelihood of having a stroke as well as a sedentary lifestyle, Robinson added.

“I would suspect that there’s not just going to be one answer out of those; that there are a lot of different things that are going to be working together to contribute to it,” Robinson said. “In terms of how do we intervene on this and reduce it? I think it’s going to start with what we know best, which is reducing cardiovascular risk factors.”

Robinson pointed to the American Heart Association’s “Essential 8,” a checklist for reducing these risks. These include eating a healthy diet, being active, not using tobacco, getting good quality sleep and managing factors such as weight, cholesterol, blood pressure and blood sugar. He added that it is important for young adults to have an established primary care doctor to screen for these levels.

“It’s important to start thinking about cardiovascular health when you’re younger,” Robinson said, “because we probably have the best chance of intervening and reducing bad outcomes if we catch it early.”

Unfortunately, the findings were not surprising but rather follow a trend that earlier studies have indicated, said Dr. Christopher Anderson, chief of the stroke division in the department of neurology at Mass General Brigham in Boston. He was not involved with the new study.

“What is significant is that the dramatic rise in rates of stroke are seen here in a population with a racial background, socioeconomic status, and education level that is fairly representative of the US population at large, making these results more likely to be generalizable across the country,” said Anderson, who is also an associate professor of neurology at Harvard Medical School.

Dr. Michelle Leppert, a vascular neurologist at Tufts Medical Center who specializes in the etiology of strokes among young adults, said she was also not surprised and stressed the importance of studies such as this one that gather data on this population. She was not involved with the study.

“The raw numbers are still not super high. But what I would say is we need to start investing time and money into understanding this question. Because it’s not a question that is going away. It’s not a problem that’s getting better,” said Leppert, who is also an associate professor of neurology at Tufts University School of Medicine.

Leppert added that strokes are still fairly rare events, so there is no need for young adults to panic. But it is crucial for everyone to go to their annual wellness checks with their doctors to identify those who might be at risk. Additionally, it is important for practitioners to recognize the rise in strokes among younger adults and hopefully identify and treat vascular risk factors early.

For young women, who more commonly have strokes than young men, they should keep a close eye on their blood pressure during pregnancy and after birth, and talk to their doctor if they have migraines with visual changes while taking birth control pills that contain estrogen, Leppert added.

“Younger adults should be aware that even in early- and mid-life, high stress, an unhealthy diet, sleep deprivation and a sedentary lifestyle have real and measurable effects on risk for diseases like stroke,” Anderson said in an email. “Sadly, that accumulated risk does not have to wait until after retirement age to have a dramatic impact on one’s health.”

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