Strokes in young people: are the numbers really on the rise?

Age is a major risk factor for having a stroke, and the risk of stroke doubles each decade after age 55. But that doesn’t mean that adults in their 20s, 30s, or 40s are too young to have a stroke or worry about high blood pressure and heart health.

In fact, the number of strokes in young adults appears to be on the rise. Globally, one in four adults older than 25 is at risk for stroke during their lifetime, according to a 25-year study published in December 2018 in the New England Journal of Medicine. Stroke risks varied geographically and were lowest among adults in eastern sub-Saharan Africa, but not because they have better heart health; researchers believe this population is at a higher risk of death from other causes.

In the United States, hospitalizations for acute ischemic strokes (in which blood flow to the brain is blocked by a clot) in people aged 25 to 44 surged by 44 percent between 2000 and 2010, according to a 2016 study published in the Journal of the American Heart Association. At the same time, admissions dropped nearly 30 percent among those between ages 65 and 84.

A separate June 2017 study published in JAMA Neurology also found that between 2003 and 2012, U.S. ischemic stroke hospitalizations jumped by 41.5 percent for men between 35 and 44 years old and increased 30 percent for women in this age group.

Is there an epidemic of ischemic stroke striking the young and middle-aged?

Not exactly, says Noor Sachdev, MD, a neurologist with Good Samaritan Hospital in San Jose, California. “I don’t think anything has changed dramatically,” he says.

So why the apparent jump in strokes in younger people?

Better education and diagnosis may play a role

Dr. Sachdev believes that better diagnosis contributed to the 44 percent increase, both on the patient side and the healthcare side. Younger adults may not suddenly be having more strokes, but people are more knowledgeable about them, Sachdev says, thanks to groups like the American Heart Association and the American Stroke Association.

“Younger people know more about the symptoms of stroke so they're coming into the hospital sooner and seeking treatment,” he says. “Our capabilities of diagnostic testing are also better."

Younger people may be better able to recover

Better diagnostic tools and greater awareness could help explain the apparent increase in strokes among young people—but what causes a stroke at a young age? While atherosclerosis (plaque buildup in arteries) is the most common cause of stroke overall, other artery problems like vasculitis, heart abnormalities, dissection (vessel tear), and blood clots are the biggest causes of strokes in young adults.

Younger patients are also more likely to recover from a stroke more quickly and fully than older adults, Sachdev adds. “Younger patients, just by the nature of the brain itself, will heal faster no matter what you do,” he says. “You don’t get brain tissue back, but you have neuroplasticity, a constant rewiring and re-networking of the brain.” People in their 20s, 30s, and 40s are generally stronger, have fewer diseases, and can better tolerate physical therapy, as well, says Sachdev.

Many stroke risk factors are controllable

Some risk factors for stroke, like sex and age, are not under your control. But there are a handful of potentially modifiable risk factors responsible for about 90 percent of all strokes worldwide, according to a 2016 study in The Lancet. These include:

• High blood pressure
• Smoking
• Excess belly fat
• Poor diet
• Alcohol consumption
• Diabetes
• Inactivity

The authors found that the most important controllable risk factor was high blood pressure. Additional studies have found it may be especially significant for younger adults.

For example, higher-than-normal blood pressure before the age of 40 was linked to a greater risk for heart disease and stroke, according to two November 2018 studies published in JAMA. One study involving nearly 5,000 Americans between ages 18 and 30 found that stage 2 hypertension (blood pressure at or above 140/90 mmHg) was linked to a 3.49 times greater risk for cardiovascular events (including stroke) than normal blood pressure.

The second study analyzed the blood pressure levels of almost 2.5 million Korean adults between the ages of 20 and 39. Compared with those with normal blood pressure, men with stage 2 hypertension had a 99 percent higher risk of stroke. Meanwhile, stage 2 hypertension more than doubled a woman's stroke risk.

Preventive steps are available

Fortunately, whether you’re 25 or 75, you can take steps to prevent a stroke. “We’ve gotten better in terms of medication, but lifestyle is key,” says Sachdev.

Start lowering your risk by changing your daily habits. “Just by meeting basic government recommendations on exercise, you can increase your life expectancy by seven years,” says Sachdev.

Research supports this idea—numerous studies have found that regular physical activity is linked to lower blood pressure levels and reduced risk of stroke. Some studies suggest that exercise is also tied to lesser chances of having recurrent strokes.

Adults should get at least 150 minutes of moderate-intensity physical activity or a minimum of 75 minutes of vigorous-intensity exercise each week, according to federal guidelines. More exercise is even better: The more you get, the greater the health benefits. But any amount of fitness is beneficial, particularly among the most sedentary people, experts advise. Even a two-minute walk can help.

“Things happen in life that you can’t control, but you can control your health,” says Sachdev. “The culture of medicine is changing with the patient taking more responsibility for their health rather than just coming to the doctor to be fixed. There’s enough knowledge out there that shows how critical lifestyle modification is to overall health and well-being.”