Strokes among those aged 20 to 54 have almost doubled in less than thirty years. In 1993-1994 there were 33.9 per 100 thousand person-years; in 2020 the rate reached 62.2. In the same period, among older adults, it dropped from 618.8 to 453. The new study records this trajectory Stroke in the Youngpublished on Neurologyconducted across five counties in the Cincinnati area and Northern Kentucky. The researchers analyzed 2,076 first strokes in people aged 20 to 54, following trends from 1993 to 2020.
The result goes in the opposite direction to that observed in the older age groups. While overall prevention and treatment have helped reduce the incidence of stroke in the elderly, in the younger group the curve continues to rise. And what drives it are above all ischemic strokes.
Almost double the number of ischemic strokes
Ischemic stroke occurs when a clot blocks blood flow to part of the brain. It is also the most common form and, in the study, it is the one that shows the most evident increase: from 23.8 cases per 100 thousand person-years in 1993-1994 to 47.3 in 2020. For intracerebral and subarachnoid hemorrhages, however, the researchers did not observe a similar growth. The increase recorded among younger people therefore seems to have a rather specific protagonist, as the University of Cincinnati also explains.
Another thing also changes. Mortality within 30 days of stroke decreased from 11.7% to 9.4%. It means that today a greater proportion of patients survive the phase immediately following the event, with all that this entails when the stroke reaches the age of 30, 40 or 50: possible disabilities to manage while working, raising a family, still having a good part of adult life ahead of you.
Why strokes are increasing among younger people
At the moment, there is no single explanation. However, within the data appears a combination rather familiar to cardiovascular medicine: hypertension, diabetes and atrial fibrillation have become more frequent over time among young adults affected by stroke. Substance use has also increased. These are conditions that for a long time we have associated almost automatically with advanced age. Instead, they can begin to accumulate much earlier.
David Robinson, a neurologist at the University of Cincinnati and one of the authors of the study, also points to the increase in obesity and sedentary lifestyle as possible pieces of the same story. High blood pressure, metabolic alterations, weight and physical activity tend to move together and can work on blood vessels for years without producing obvious symptoms.
The American Heart Association considers blood pressure, cholesterol, diabetes, smoking and weight among the main elements linked to cardiovascular risk. For younger adults, there is a lot of time ahead: enough for small, ignored problems to become decidedly less small.
High blood pressure and diabetes can exist without being felt
Here comes the less intuitive part. A person in their forties may feel perfectly well and already have high blood pressure, high cholesterol, or out-of-control blood sugar. Hypertension, in particular, remains one of the major modifiable factors linked to stroke. Then there are diabetes, cholesterol, smoking, excess weight and a sedentary lifestyle.
The American Heart Association’s guidelines on primary stroke prevention also insist on regular physical activity and reducing time spent completely sedentary. Cincinnati’s work then adds a rather concrete element: these factors are not politely waiting for the pension before presenting the bill.
Substance use has also increased
Among the youngest patients in the study, substance use also increased significantly: from 4.6% in 1993-1994 to 40.2% in 2020. According to the researchers, a large part of the increase reflects the use of marijuana.
Specialists also draw attention to stimulants such as cocaine and methamphetamine, which are already linked to an increase in cerebrovascular risk. Meanwhile, the evolution of consumption habits adds another variable to a population in which hypertension, diabetes and heart problems appear more and more often.
The authors of the study now intend to better understand how much each of these elements contributes to the observed growth. For the moment we know that they are moving in the same direction.
What can we do before age 55
Measuring your blood pressure every now and then, knowing your blood sugar and cholesterol levels, not smoking, staying physically active and taking action on your weight when necessary seem almost boring advice. They also have the flaw of being the ones who keep coming back every time we talk about cardiovascular prevention.
The American Heart Association summarizes prevention in eight areas: nutrition, exercise, tobacco, sleep, weight, cholesterol, blood sugar and blood pressure. For stroke, blood pressure control remains one of the central interventions.
And then you have to recognize it when it arrives. Suddenly crooked mouth, weakness or loss of sensation on one side of the body, difficulty speaking, seeing or walking are among the symptoms indicated by the Ministry of Health. In these cases, time counts and you need to call for help immediately. Because stroke continues to strike, especially at an advanced age. Except that the Cincinnati data show with some clarity that, under the age of 55, he has already begun to take up a lot of space.
