Why is the age for stroke patients skewing younger?
By Deborah Jeanne Sergeant
Stroke is the fifth leading cause of death in the US and the leading cause of long-term adult disability, according to the American Heart Association. Historically, the age of onset is usually 65-plus.
However, the Centers for Disease Control and Prevention states in an online report that prevalence among younger patients is increasing.
From 2011–13 to 2020–22, stroke jumped by 14.6% among adults aged 18 to 44 and by 15.7% among people aged 45 to 64.
“This is especially alarming since stroke rates among the population overall is declining,” said physician Grahame Gould, board member with the American Heart Association and neurosurgeon specializing in cerebrovascular neurosurgery and interventional neuroradiology at Upstate University Medical Center. “We don’t know exactly why this is occurring, but we have learned that, aside from regular stroke risk factors, young people also have increased stroke risk associated with non traditional risk factors like migraine headaches, heavy alcohol consumption, blood clotting disorders, autoimmune disease and kidney failure.
“Possibly, we are also seeing higher rates because of increased sedentary lifestyle and poor diet among younger populations who do not think about or learn about stroke, further putting them at risk because of under diagnosis and delayed treatment.”
People can mitigate 90% of stroke risk by addressing modifiable conditions.
The CDC states that only 24.2% of adults who are currently 18 and older meet the physical activity guidelines for both aerobic and muscle-strengthening activity, compared with 31% in 2000. The National Institutes of Health states that US obesity rates have tripled over the past 60 years — and onset of obesity has shifted younger than ever.
Physician Fahed Saada, section chief of neurology at St. Joseph’s Health, said that tobacco use — especially vaping — is widespread among even teenagers.
“We’re seeing more young people with strokes, which challenges the notion that stroke is an older person’s condition,” he said.
Saada wants more providers to screen younger teens for tobacco use, drug use and vaping, as “research shows they harm their blood vessels, increase clotting and raise blood pressure,” he said. “Studies including a 2022 analysis from the American Medical Association have linked vaping to a significantly higher stroke risk compared with non users, sometimes surpassing regular cigarettes in some age ranges.”
He also noted that sedentary lifestyles and diets heavy in processed foods are shifting the timeline to earlier onset for higher stroke risk. When these risk factors manifest earlier, the patient experiences higher risk for stroke earlier since the damage occurs earlier.
These effects are especially ruinous in that younger people remain unaware of the risk factors and they don’t seek routine healthcare like physicals.
“Many younger adults have high blood pressure, diabetes or high cholesterol — often without realizing it,” said Joshua Onyan, registered nurse and stroke program manager at Upstate University Hospital. “These conditions can silently damage blood vessels over time, increasing the risk of stroke.”
Why go to the doctor when you feel fine?
Most in this age range are busy launching careers and starting families.
“Many people work long hours at desks and don’t get enough physical activity,” Onyan said. “A lack of exercise can contribute to weight gain, high blood pressure and poor circulation, all of which increase stroke risk.”
To an extent, physicians look at other factors when younger adults experience stroke such as clotting disorders, autoimmune conditions (many of which tend to present during young adulthood) and pregnancy.
“While these cases are less common, they highlight the need for awareness and early detection,” Onyan said.
Genetic factors can put people at higher risk. A study by the NIH in 2021 indicates that about half of the factors for stroke are non modifiable such as age and genetics and the other half are modifiable. Black people are at higher risk for experiencing stroke and dying from one than people of other races, for example.