Why do young people get strokes?

June 21, 2024
Avatar for Jyoti Kinghorn, PhDJyoti Kinghorn, PhD
Young people can have strokes

Strokes in young people are increasing at an alarming rate with 10% of all strokes now occurring in the under-50 demographic. Strokes are a serious medical emergency. They are the fifth leading cause of death and a leading cause of long-term brain damage and physical disability.

How does a stroke happen?

Strokes happen when there is a blockage in an artery that takes blood to the brain (ischemic stroke), or there is bleeding in the brain (hemorrhagic stroke). As a result, some parts of the brain become deprived of oxygen and begin to die. If blood flow is not restored, a stroke can cause permanent brain damage and even death. Brain damage can lead to cognitive issues, and may reduce functionality of various body parts. A person may be unable to grasp and hold things effectively, or lose control over their bladder or bowels.

The disturbing trend of strokes in children and young adults

Strokes used to be regarded as a risk for older individuals over the age of 55. However, the incidence of strokes in younger individuals has been sharply rising and the average age at stroke onset has been decreasing for the past few decades.

In a study, researchers followed the health of young participants from three different age groups: 5-14, 15-34, and 35-44. From 1995 to 2008, the researchers measured the prevalence of hospitalizations due to stroke in these age groups.

They observed that during the period of the study, more and more hospitalizations were reported due to ischemic stroke in nearly all age groups. Females who were 5-14 years old did not have an increased prevalence of ischemic stroke but did have increased chances of getting a stroke from subarachnoid hemorrhage. When the researchers looked at coexisting conditions, they found that conditions such as high blood pressure, obesity, diabetes, and tobacco use had also increased in these age groups. All these conditions increase the risk of having a stroke.

Another study conducted over 15 years observed the incidence of primary intracerebral hemorrhagic (ICH) strokes in young and middle-aged adults. This study revealed that between 2004 and 2018, there was a shocking increase in the incidence of ICH by 38% in 18–44-year-olds. Among 45–64-year-olds, there was an increase in the incidence of ICH by 33%. The researchers also observed that there was a 16% overall increase in hypertension. Hypertension is one of the main risk factors for ICH strokes.

Reasons why young people are getting more strokes

Sometimes strokes occur due to risk factors outside of someone’s control, such as a congenital heart defect. However, the recent uptick in strokes in young individuals is primarily attributed to poor management of preventable risk factors.

The following are the preventable stroke risk factors that are affecting the youth more than they did in the past decades.

1. Obesity

Obesity among the young has been increasing. Data collected between 2017-2020 showed that 19.7% of youths in the U.S. aged 2-19 were obese. In the 1970s, only 5% of youth in this age group were obese. This increase in the rates of obesity has increased the risk of many adverse health outcomes including stroke.

2. High blood pressure

Currently, 4% of youths in the US aged 12-19 have hypertension. Hypertension, or persistently high blood pressure increases the risk of strokes. Obesity is one of the primary risk factors for hypertension.

3. Hypercholesterolemia

Hypercholesteremia (high levels of bad cholesterol) contributes to the formation of plaques in the arteries (atherosclerosis) which increases the risk of stroke and heart attack. At least 7% of US youths aged 6-19 have high levels of total cholesterol.

4. Diabetes

Having diabetes can double the risk of having a stroke. The incidence of diabetes among the youth has doubled over the last 2 decades. This trend is attributed at least in part to the growing rates of obesity.

5. Tobacco use

Smoking cigarettes increases the risk of having a stroke. While the proportion of youth who use tobacco products has decreased now compared to the 1970s, about 10% of US middle and high school students still use tobacco, often in the form of vaping. Unlike cigarettes, the connection between vaping and strokes is not well established yet. However, it has been suggested that vaping may increase the risk of cardiovascular disease and stroke.

6. Pregnancy and the postpartum period

Women are at risk of stroke during their pregnancy and in the post-partum period. Not only are their body’s hormonal levels changing, but there is also an increased risk of the formation of blood clots which continues for 12 weeks after giving birth. Gestational diabetes, hypertension, and migraine headaches are some of the risk factors that further increase the risk of stroke during pregnancy. About 20% of strokes in women under 30 are pregnancy-related.

7. Oral contraceptives

Oral contraceptives with high estrogen doses have been linked with an increased risk of ischemic stroke in patients who also had other risk factors such as hypertension and smoking.
Based on the national survey data from 2017-2019, the CDC reported that 14% of women in the US between the ages of 15 and 49 used oral contraceptive pills for birth control.

A large study with 2,143,174 participants revealed that oral contraceptives containing estrogen increased the risk of both ischemic and hemorrhagic strokes. The longer the pills were used, the greater was the risk of ischemic strokes but not hemorrhagic strokes. Cessation of pills was associated with a lower risk of strokes for both ischemic and hemorrhagic strokes. The dose of estrogen is important too. Higher doses of estrogen were associated with a greater risk of stroke.

However, another study indicated that while there was a risk of stroke during the first year of using estrogen-based contraceptive pills, the risk went down after the first year.

Studies have found no increased risk of stroke when using non-hormonal birth control and progestin-only birth control.

8. Illegal drug use

Illegal drug use among youth is increasing sharply. Just between 2016 and 2020, drug use among 8th graders went up by 61%. Drug abuse increases the risk of stroke in several ways. Drugs can raise blood pressure which can damage blood vessels, or slow down breathing which can result in oxygen deprivation and stroke.

Prevention of strokes

Because many factors that increase the risk of stroke in young people are preventable, some providers attribute the increasing number of strokes primarily to poor lifestyle choices.

The best way to prevent strokes among youth is to minimize risk factors such as obesity and drug use and carefully control any existing risk factors such as hypertension and diabetes. Women should discuss their risk of stroke with their ob/gyn during their birth control consultation, throughout pregnancy, and during the postpartum period.

A health-centered lifestyle with a good diet and exercise that supports healthy body weight, cholesterol level, and blood pressure would reduce the risk of stroke.

B.E. F.A.S.T. when someone is having a stroke

Use the “B.E. F.A.S.T.” method for identifying and responding to strokes:

Balance: A sudden loss of balance or dizziness experienced by you or someone around you can be a sign of a stroke.

Eyes: A sudden loss of vision from one or both eyes can be a sign of a stroke.

Face: Check the face and smile. A stroke can cause one side of the face to look droopy, and a smile to look uneven.

Arm: Check the strength of the arms. A stroke can make one side of the body weaker. If both arms are raised, one may fall back down.

Speech: Is there clear speech? Watch for slurring and lack of understanding.

Time. Time is of critical importance during a stroke. Quick medical intervention can stop permanent brain damage or death. If you suspect you or someone around you is having a stroke, call 911 and ask for an ambulance. The medics on board can start the treatment on the way to the hospital.

The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.

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