Q&A: Addressing stroke risk factors in younger persons a complex issue

Key takeaways:

• While some stroke risk factors such as smoking have declined, others such as obesity have risen in recent years.
• The most important thing for young people to know about stroke is recognizing symptoms.

According to statistics reported in a recent release from Sutter Health, up to 15% of strokes are suffered by individuals aged younger than 45 years, with incidence rising.

Healio spoke with Steven Shapiro, MD, medical director for Stroke Services at RWJ Barnabas Health’s Cooperman Barnabas Medical Center in New Jersey, on the factors that have led to a rise in strokes among young people and what can be done to reverse the trend.

Healio: In light of the statistics cited above, how long ago did researchers first notice the increased risk among younger persons?

Shapiro: Researchers and doctors have been noticing an uptick in stroke cases among younger people for years. I suspect this may be due to lifestyle factors that have increased the prevalence of certain health conditions in younger people, such as hypertension and diabetes, which historically were risk factors for older patients.

Technology has advanced significantly in recent years, enhancing our ability to detect strokes in patients. While strokes are becoming more prominent among younger generations, I believe this is partly because more young patients are being scanned and diagnosed with ischemic strokes, contributing to the rise in reported cases.

Healio: One aspect of the cited increase is alarming: Risk factors such as smoking, heavy drinking, diabetes, high blood pressure and high cholesterol are the same for younger sufferers as older. Have these risk factors decreased, stayed consistent or increased over the last 20 to 25 years?

Shapiro: The prevalence of certain risk factors for stroke among younger individuals has shown an alarming trend in recent years. Some risk factors, like smoking, have seen a decline, likely due to public health campaigns. Others, such as obesity, diabetes and high blood pressure, have increased among younger populations. Heavy drinking, drug use and high cholesterol levels have remained relatively consistent. These mixed trends highlight the complexity of addressing stroke risk factors in younger individuals and underscore the need to educate the younger populations on the warning signs.

Healio: Are there other factors at play such as environmental or familial which may negatively impact risk of stroke for younger individuals?

Shapiro: The environment in which an individual lives and their lifestyle plays a role. As an example, while there is no direct link between air pollution and stroke, a chronic, toxic exposure can lead to a number of health consequences which may ultimately lead to increased risk of stroke. Lifestyle factors that are often unique to the younger population, such as drug use or use of illicit supplemental substances, can put an individual at higher risk.

Additionally, I think strokes have a very familial component. Many of the traditional “lifestyle” risk factors, such as obesity, hypertension, and diabetes, are all things that have a strong connection to a patient’s genetic profile.

Healio: Can you address any concerns or issues regarding longer-term care for those who suffer a stroke at a younger age?

Shapiro: The most important thing for a young person to know regarding stroke care is knowing the symptoms. For young people who have decades ahead of them, it is so important to get to the hospital, as soon as possible; this is particularly true about getting to a center that specializes in advanced stroke care, such as ours. In this way, potentially large strokes can be treated promptly.

We saw a 39-year-old patient recently who had an extreme dissection of his left carotid artery, which sent a clot up to his brain. If left untreated, this clot had the potential to leave the patient with disabling right sided paralysis and severe language deficits.

In the past, and perhaps even today, at other centers without advanced therapies, he may have ended up severely disabled for the rest of his life. However, because he recognized the signs and got to the hospital quickly, RWJ Barnabas Health doctors were able to perform surgery and restore blood flow to the left side of the brain. He made a full recovery and was able to be discharged home within 2 days.

Healio: Aside from attending to lifestyle changes, what advice or counsel can you offer to reduce stroke risk in younger persons?

Shapiro: Recognizing common warning signs of a stroke is crucial.

I’d like to emphasize the importance of the “BE-FAST” acronym, which is used to determine whether someone may be experiencing stroke symptoms:

Studies have shown that, for every minute that passes in a stroke, approximately 1 million neurons become irreversibly injured. For an occlusion of a large vessel, every 30 minutes of delays to treatment adds 5 years of age to the brain and a 30% lower chance of a good functional recovery. This is especially true for younger individuals, where decades of disability-years can be avoided with prompt recognition and treatment.

As we say in the stroke community, “Time is Brain.”

Reference:

Stroke Before Age 45. https://www.sutterhealth.org/health/heart/stroke-before-age-forty-five. Accessed May 20, 2024.