A research team led by scientists at the University of Cincinnati, Ohio, recently set out to analyze stroke incidence data to see how trends in these cardiovascular events have evolved over time and published their findings in the journal Neurology.
The team examined stroke cases requiring hospitalization in the Greater Cincinnati and Northern Kentucky region across six time periods: July 1993–June 1994, and the calendar years of 1999, 2005, 2010, 2015, and 2020.
Previous findings indicated that the overall incidence of stroke cases had declined over the 27-year study period. However, the current analysis suggested that strokes had actually become more common among younger adult populations, ages 20 to 54.
Specifically, they noted an increase from 33.9 cases per 100,000 person-years in 1993-1994 to 62.2 cases per 100,000 person-years in 2020 among these younger populations.
Most of the stroke cases among younger adults, the researchers also noted, were of ischemic stroke, whose rates increased from 23.8 cases per 100,000 person-years in 1993-1994 to 47.3 cases per 100,000 person-years in 2020.
Speaking to Medical News Today, David Robinson, MD, assistant professor in the Department of Neurology and Rehabilitation Medicine at the University of Cincinnati, who is the senior author of the study, explained:
Read more:NWSL expansion club Atlanta City FC unveils red and Georgia peach branding
“We have a long-running research study in the Greater Cincinnati/Northern Kentucky region that has been monitoring the burden of stroke in the United States since 1988. We have observed clear declines in the overall number of people who experience strokes, which is a great testament to all the public health efforts that have targeted prevention of this disease and should be celebrated; however, even as the total number declined, the people who were having strokes were getting younger and younger.”
“We wanted to understand why that was happening,” Robinson told us. “At the same time, data from death certificates in the United States suggested that stroke was more commonly being listed as a cause of death in younger people.”
“Death certificate data is really hard to interpret,” he pointed out. “More deaths with stroke listed as the cause can be the result of stroke becoming more common, or it can reflect changes in how physicians fill the certificates out, or it can be related to a higher proportion of more severe strokes leading to death.”
“Our study [was] able to look at younger individuals with stroke in a more granular way over a very long period of time. We also felt that any changes in this age group were really important to study in general. Stroke is devastating at any age, but it is particularly challenging in younger people since they are still in their prime working years and may have young families to care for,” said the researcher.
“There may not be one simple explanation why strokes are rising in young individuals,” said Robinson.
Read more:Netanyahu is using Mamdani as a foil in his re-election campaign | Mohamad Bazzi | The Guardian
According to him, “there is no doubt that several ‘traditional’ stroke risk factors are rising in younger adults, including high blood pressure and diabetes, and we saw that in our study population as well.”
“High blood pressure has one of the closest relationships with stroke of any risk factor, so this could be part of the story,” he noted. Nevertheless, the study author hypothesized that there are more factors at play here:
“It’s well known that obesity and sedentary lifestyles have become dramatically more common over the last 3 decades, and this could certainly contribute to what we saw. We also noted a much higher rate of illicit substance use in our population over time, with the most common substance being marijuana [cannabis]. There is some evidence that marijuana use can increase your risk of stroke, but it remains unclear whether it is a strong enough independent risk factor to explain the rising burden we observed.”
“All of these factors will need to be studied in more depth,” he told us.
Walavan Sivakumar, MD, a board certified neurosurgeon, director of neurosurgery, and chief of staff at Providence Little Company of Mary in Torrance, CA, who was not involved in this study, advanced a similar hypothesis about the findings.
Like Robinson, Sivakumar believes that “the increase in stroke among younger adults is likely multifactorial.” He also noted that “the study points to a concerning rise in traditional cardiovascular risk factors, including hypertension, diabetes, and atrial fibrillation.”
“These conditions are increasingly being diagnosed in younger adults and can significantly increase stroke risk,” the neurosurgeon explained.
He also expressed concern about the apparent rise in cannabis use and potentially that of illicit stimulant drugs among younger populations.
“While this association does not prove that marijuana itself causes stroke, it is a pattern that warrants further investigation, particularly when combined with stimulant use such as cocaine or methamphetamine, which have much stronger and more established associations with stroke,” he told MNT.
Speaking of what individuals can do to decrease their risk of stroke, Robinson advised following the American Heart Association (AHA)’s “Life’s Essential 8” guidelines, “specifically, controlling blood pressure, avoiding tobacco use, eating better, sleeping better, controlling blood sugar, controlling cholesterol, managing weight, and being as active as possible.”
Read more:Cancer: Blood test trends may predict risk better than single test
“Addressing these issues can not only reduce your risk of a stroke in the near term, but can go along way toward keeping you healthy once you get older,” Robinson explained.
“Prevention really is the best tool that we have. If I were to recommend one thing, it would be to look for opportunities to screen for high blood pressure, which is often asymptomatic early on and can do a lot of damage before you are diagnosed,” the study author concluded.
Sivakumar concurred, noting that “adults should have their blood pressure and blood sugar checked regularly and work with their physicians to address abnormalities rather than assuming they are too young to be at risk.”
“People who experience palpitations or have other risk factors or a family history of heart rhythm disorders should discuss whether evaluation for an irregular heart rhythm, such as atrial fibrillation, is appropriate. It is also important to be candid with your physician about substance use, including marijuana and stimulants, so that it can be considered as part of your overall risk profile.”
— Walavan Sivakumar, MD
“Finally, everyone should know the warning signs of stroke, including sudden facial drooping, arm weakness, or difficulty speaking,” stressed the neurosurgeon. “These symptoms require immediate medical attention regardless of a person’s age. Rapid treatment can save brain function and improve outcomes.”
Read more:Liverpool’s Alexander Isak leaves Sweden camp early with ‘minor injury’
Like Robinson, Sivakumar expressed that the current study suggests there is dire need of further research to confirm why exactly cardiovascular risk factors “are becoming more prevalent in younger adults and how strongly each factor contributes to stroke risk.”
“It would also be valuable to investigate the increasing incidence of atrial fibrillation and cardioembolic stroke in younger adults,” he noted.
“Understanding whether earlier screening for cardiovascular risk factors or heart rhythm abnormalities could identify people at increased risk before they experience a stroke could have important implications for prevention,” Sivakumar explained.
Furthermore, the neurosurgeon commented that longer-term studies should examine whether earlier intervention targeting key modifiable risk factors “can reverse these trends.”
“The fact that stroke survival is improving is encouraging, but preventing strokes in the first place, particularly among younger adults, should remain a major goal,” he stressed.
