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Stroke rates in adults aged 20 to 54 have almost doubled over nearly three decades.The increase was mostly due to a jump in the number of ischemic strokes.Doctors have a few theories on what\u2019s fueling the increase\u2014and how you can protect yourself. <\/p>\n
Stroke is one of the leading causes<\/a> of death and disability in the U.S., making prevention strategies<\/a> crucial. But while many people associate strokes with older adults, startling new research suggests that younger adults are experiencing more strokes\u2014and the rate is increasing rapidly.<\/p>\n The new study<\/a>, which was published in the journal Neurology, analyzed data on strokes in the Greater Cincinnati and Northern Kentucky region from 1993 through 2020. The researchers detected 2,076 first-ever strokes in adults aged 20 to 54.<\/p>\n After crunching the data, they discovered that the rate of strokes in younger adults increased from 33.9 cases per 100,000 person-years in 1993 to 1994 to 62.2 cases per 100,000 person-years in 2020. During the same time period, strokes actually declined in older adults, from 618.8 cases per 100,000 person-years to 453.0 per 100,000 person-years. (Person-years is a combined unit of measurement that looks at the number of people in a study and the amount of time each person participates in it.)<\/p>\n The increase in cases was largely driven by growing numbers of ischemic strokes, which occurs when a blood clot blocks<\/a> a blood vessel in the brain. It\u2019s by far the most common kind of stroke, making up 87% of all strokes, per the Centers for Disease Control and Prevention (CDC)<\/a>.<\/p>\n According to the study, the rate of ischemic stroke rose from 23.8 cases per 100,000 person-years in 1993\u20131994 to 47.3 cases per 100,000 person-years in 2020. The study didn\u2019t find similar increases in other types of stroke.<\/p>\n So that means in less than three decades, cases of the most common kind of stroke nearly doubled in adults under the age of 55.<\/p>\n And these younger adults didn\u2019t \u201cjust\u201d experience a stroke: They also were more likely to develop additional health problems over time, including high blood pressure<\/a>, diabetes, and atrial fibrillation<\/a>, and substance use.<\/p>\n \u201cWe 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,\u201d says David Robinson, M.D.<\/a>, senior study author and assistant professor of clinical neurology and rehabilitation medicine at the University of Cincinnati. \u201cHowever, even as the total number declined, the people who were having strokes were getting younger and younger.\u201d<\/p>\n He points out that stroke is \u201cdevastating 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.\u201d<\/p>\n So what\u2019s fueling this increase in younger adults? Experts have a few theories.<\/p>\n Meet the experts: David Robinson, M.D.<\/a>, senior study author and assistant professor of clinical neurology and rehabilitation medicine at University of Cincinnati; Christian Ferreira, M.D.,<\/a> cerebrovascular surgeon and neuro-interventionist at Northwell\u2019s Phelps Hospital in Sleepy Hollow, N.Y.; Walavan Sivakumar, M.D.<\/a>, neurosurgeon, director of neurosurgery, and chief of staff at Providence Little Company of Mary in Torrance, CA; Elizabeth Rosen, M.D<\/a>., neurologist at Tufts Medical Center; Davide Cappon, Ph.D<\/a>., director of neuropsychology at Tufts Medical Center.<\/p>\n Why are strokes increasing in younger adults?<\/p>\n This new study didn\u2019t explore why the stroke rate is rising in younger adults\u2014it just discovered an increase. \u201cThere probably isn\u2019t a single explanation,\u201d says Christian Ferreira, M.D.,<\/a> cerebrovascular surgeon and neuro-interventionist at Northwell\u2019s Phelps Hospital in Sleepy Hollow, NY.<\/p>\n Add Prevention as a preferred source in your Google search results.<\/p>\n Use your Google account to add this to your settings.<\/p>\n Add to Google settings<\/p>\n But Dr. Ferreira points out that traditional risk factors for stroke are becoming more common in younger adults. \u201cHypertension, diabetes, and atrial fibrillation\u2014an irregular heartbeat\u2014all became more prevalent over the study period,\u201d he says.<\/p>\n Walavan Sivakumar, M.D.<\/a>, neurosurgeon, director of neurosurgery, and chief of staff at Providence Little Company of Mary in Torrance, CA, calls the findings \u201csobering, but not entirely surprising\u201d based on what he\u2019s seen with patients. The study also discovered a big increase in substance use, especially marijuana, in stroke patients, he points out.<\/p>\n \u201cThis doesn\u2019t necessarily prove marijuana causes stroke on its own, but combined with stimulant use like cocaine and methamphetamine, which have a much stronger and more established link to stroke, it\u2019s a pattern worth taking seriously,\u201d he says.<\/p>\n Rising obesity rates also likely play a role, according to Dr. Robinson. \u201cIt\u2019s well known that obesity and sedentary lifestyles have become dramatically more common over the last three decades, and this could certainly contribute to what we saw,\u201d he says.<\/p>\n \u201cThe important message is that the risk factors we traditionally associate with stroke in older adults can begin accumulating decades earlier,\u201d says Elizabeth Rosen, M.D<\/a>., neurologist at Tufts Medical Center.<\/p>\n Ultimately, the findings raise a lot of questions. \u201cThis study cannot prove that these changes caused the increase in stroke,\u201d Dr. Ferreira says. \u201cHowever, the findings reinforce something we increasingly recognize clinically: Being relatively young does not protect someone from the consequences of hypertension, diabetes, obesity, smoking, and other vascular risk factors.\u201d<\/p>\n Why are these largely ischemic strokes?<\/p>\n Ischemic stroke is already the most common type of stroke and that trend may simply be continuing with younger adults, Dr. Rosen says.<\/p>\n This study also found an increase in cardioembolic stroke\u2014a specific type of ischemic stroke, where the clot comes from the heart\u2014and atrial fibrillation over time, she says. \u201cSo, the pattern may reflect younger adults developing traditionally \u2018older\u2019 vascular and cardiac risk factors earlier in life.\u201d<\/p>\n But it\u2019s also possible that certain advancements in preventive care may play a role, too: Healthcare providers may be getting better at spotting other factors that contribute to other types of stroke sooner, Dr. Robinson says. \u201cFor instance, one type of hemorrhagic stroke is caused by aneurysms, where a blood vessel wall becomes weak and balloons out, making it prone to rupture,\u201d he says. \u201cModern imaging can more easily find these aneurysms before they rupture and surgeons are much more likely to treat them prophylactically.\u201d As a result, those aneurysms may be fixed before they end up causing a stroke.<\/p>\n How to protect yourself from stroke<\/p>\n Doctors stress the importance of staying on top of stroke risk factors now. \u201cProtecting brain health starts well before old age,\u201d says Davide Cappon, Ph.D<\/a>., director of neuropsychology at Tufts Medical Center.<\/p>\n![\"Google\"](\"https:\/\/www.prevention.com\/_assets\/design-tokens\/fre\/static\/icons\/social\/google.1467f37.svg\")
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