Stroke rates among young adults have nearly doubled

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Most people don’t worry about their cardiovascular health until they get older. But strokes, one type of cardiovascular disease, in young adults are steadily on the rise — and have nearly doubled in the last three decades, according to a new study.

“Stroke is a very devastating disease at any age. It is particularly devastating when it happens to younger people,” said Dr. David Robinson, senior author of the study published Wednesday in the medical journal Neurology.

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Researchers found that the rate of strokes among younger adults increased from 33.9 cases per 100,000 people in 1993 to 1994 to 62.2 cases per 100,000 people in 2020. The study also reported a slight increase in people surviving strokes, suggesting that more younger adults may be living with the long-term effects of a stroke.

“The disability that can result from stroke can make it much harder to do all the things you need to do to live your life,” such as working or keeping up with young children, said Robinson, an assistant professor of clinical neurology and rehabilitation medicine at the University of Cincinnati College of Medicine.

“Knowing that this is possible — that stroke doesn’t just happen in older people, that it can happen in younger people — and that there are ways in which we can try our best to prevent this is really an important takeaway,” Robinson said.

Here’s what experts recommend for young adults to know to help protect cardiovascular health and reduce the risk of a stroke.

The study looked at strokes among adults ages 20 to 54 in the greater Cincinnati and northern Kentucky region. From 1993 through 2020, there were 2,076 first-ever strokes among the population, with 738 cases occurring in Black individuals (35.6%) and 1,030 cases occurring in female individuals (49.6%).

Ischemic strokes — the most common type of stroke — primarily drove the increase, according to the study. These occur when blood flow to part of the brain is blocked.

The researchers also noted a rise in stroke risk factors across the 27-year period, with hypertension increasing from 47% to 60%, diabetes from 19% to 26%, atrial fibrillation from 1% to 6% and substance use from 5% to 40%, largely attributable to increased marijuana use.

However, since there is no comparable data from people without stroke, the study authors cannot determine if these trends in risk factors explain the increase in stroke rates.

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Furthermore, while these trends were also observed in older people, the numbers for strokes in older adults has not risen. “It might be part of the story,” Robinson said, “but I don’t think it’s the entire story here.”

The rise of health issues such as obesity and high cholesterol can also contribute to the likelihood of having a stroke as well as a sedentary lifestyle, Robinson added.

“I would suspect that there’s not just going to be one answer out of those; that there are a lot of different things that are going to be working together to contribute to it,” Robinson said. “In terms of how do we intervene on this and reduce it? I think it’s going to start with what we know best, which is reducing cardiovascular risk factors.”

How to recognize signs of a stroke with the acronym BE FAST

Robinson pointed to the American Heart Association’s “ Essential 8 ,” a checklist for reducing these risks. These include eating a healthy diet, being active, not using tobacco, getting good quality sleep and managing factors such as weight, cholesterol, blood pressure and blood sugar. He added that it is important for young adults to have an established primary care doctor to screen for these levels.

“It’s important to start thinking about cardiovascular health when you’re younger,” Robinson said, “because we probably have the best chance of intervening and reducing bad outcomes if we catch it early.”

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Unfortunately, the findings were not surprising but rather follow a trend that earlier studies have indicated, said Dr. Christopher Anderson, chief of the stroke division in the department of neurology at Mass General Brigham in Boston. He was not involved with the new study.

“What is significant is that the dramatic rise in rates of stroke are seen here in a population with a racial background, socioeconomic status, and education level that is fairly representative of the US population at large, making these results more likely to be generalizable across the country,” said Anderson, who is also an associate professor of neurology at Harvard Medical School.

Dr. Michelle Leppert, a vascular neurologist at Tufts Medical Center who specializes in the etiology of strokes among young adults, said she was also not surprised and stressed the importance of studies such as this one that gather data on this population. She was not involved with the study.

“The raw numbers are still not super high. But what I would say is we need to start investing time and money into understanding this question. Because it’s not a question that is going away. It’s not a problem that’s getting better,” said Leppert, who is also an associate professor of neurology at Tufts University School of Medicine.

Leppert added that strokes are still fairly rare events, so there is no need for young adults to panic. But it is crucial for everyone to go to their annual wellness checks with their doctors to identify those who might be at risk. Additionally, it is important for practitioners to recognize the rise in strokes among younger adults and hopefully identify and treat vascular risk factors early.

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Mediterranean diet associated with lower risk of stroke in women

For young women, who more commonly have strokes than young men, they should keep a close eye on their blood pressure during pregnancy and after birth, and talk to their doctor if they have migraines with visual changes while taking birth control pills that contain estrogen, Leppert added.

“Younger adults should be aware that even in early- and mid-life, high stress, an unhealthy diet, sleep deprivation and a sedentary lifestyle have real and measurable effects on risk for diseases like stroke,” Anderson said in an email. “Sadly, that accumulated risk does not have to wait until after retirement age to have a dramatic impact on one’s health.”

Taylor Nicioli is a freelance journalist based in New York.

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大多数人直到年纪大了才会开始关注心血管健康。但一项新的研究表明，中风（一种心血管疾病）在年轻人中的发病率正在稳步上升，并且在过去三十年中几乎翻了一番。

“中风在任何年龄段都是一种非常严重的疾病。但对于年轻人来说，它的危害尤其巨大，”该研究的资深作者大卫·罗宾逊博士说。该研究于周三发表在医学期刊《神经病学》上。

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吸烟会导致心脏病和中风。许多吸烟者并不知道这一点。

研究人员发现，1993年至1994年，年轻成年人的中风发病率为每10万人33.9例，而2020年则上升至每10万人62.2例。该研究还报告称，中风幸存者人数略有增加，这表明更多年轻成年人可能正在承受中风的长期影响。

“中风造成的残疾会使人们更难做生活中需要做的所有事情，”辛辛那提大学医学院临床神经病学和康复医学助理教授罗宾逊说，例如工作或照顾年幼的孩子。

罗宾逊说：“知道中风并非只发生在老年人身上，年轻人也会中风，并且我们可以通过各种方式尽力预防中风，这真的是一个非常重要的收获。”

以下是专家建议年轻人了解的有助于保护心血管健康和降低中风风险的知识。

该研究调查了辛辛那提大都会区和肯塔基州北部地区20至54岁成年人的中风情况。从1993年到2020年，该地区共有2076例首次中风病例，其中738例发生在黑人（35.6%），1030例发生在女性（49.6%）。

研究表明，缺血性中风——最常见的中风类型——是导致中风病例增加的主要原因。缺血性中风是指大脑某部分的血液供应受阻。

研究人员还注意到，在 27 年期间，中风风险因素有所增加，高血压从 47% 增加到 60%，糖尿病从 19% 增加到 26%，房颤从 1% 增加到 6%，药物滥用从 5% 增加到 40%，这主要归因于大麻使用量的增加。

然而，由于没有来自未患中风人群的可比数据，研究作者无法确定这些风险因素的趋势是否能解释中风率的上升。

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这种非医疗干预措施可能降低您的中风风险。

此外，虽然老年人群中也观察到了这些趋势，但老年人中风的病例数并未上升。“这或许是原因之一，”罗宾逊说，“但我认为这并非全部原因。”

罗宾逊补充说，肥胖和高胆固醇等健康问题的增加以及久坐不动的生活方式也会增加中风的风险。

罗宾逊说：“我怀疑这些问题不会只有一个答案；很多不同的因素共同作用导致了这种情况。至于我们如何干预并降低发病率？我认为应该从我们最擅长的领域入手，那就是降低心血管疾病的风险因素。”

如何通过“BE FAST”这个口诀识别中风迹象

罗宾逊指出，美国心脏协会提出了“八项基本原则”，这是一份降低这些风险的清单。这些原则包括健康饮食、积极运动、不吸烟、保证充足睡眠以及控制体重、胆固醇、血压和血糖等因素。他还补充说，年轻人应该定期找一位固定的家庭医生进行这些指标的筛查。

罗宾逊说：“年轻时就开始考虑心血管健康非常重要，因为如果我们及早发现问题，就有最大的机会进行干预并减少不良后果。”

超过25%的Z世代患者没有家庭医生。专家们就放弃就医的代价发表了看法。

麻省总医院布莱根医院神经内科卒中科主任克里斯托弗·安德森博士表示，遗憾的是，研究结果并不出人意料，而是与之前的研究结果相符。他并未参与这项新研究。

“值得注意的是，中风发病率的急剧上升发生在一个种族背景、社会经济地位和教育水平与美国整体人口相当的人群中，这使得这些结果更有可能在全国范围内得到推广，”安德森说道，他同时也是哈佛医学院的神经病学副教授。

塔夫茨医疗中心血管神经科医生米歇尔·莱珀特博士专门研究青年人中风的病因，她表示对此并不感到意外，并强调了此类收集该人群数据的研究的重要性。她并未参与这项研究。

“虽然原始数字仍然不算很高，但我认为我们需要开始投入时间和金钱来了解这个问题。因为这个问题不会消失，也不会好转，”莱珀特说道，他同时也是塔夫茨大学医学院的神经病学副教授。

莱珀特补充说，中风仍然相当罕见，所以年轻人无需恐慌。但至关重要的是，每个人都应该每年进行健康检查，以便医生识别潜在的高危人群。此外，医务人员也必须意识到年轻人中风病例的增加，并尽可能及早发现和治疗血管危险因素。

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地中海饮食与女性中风风险降低有关

莱珀特补充说，年轻女性比年轻男性更容易中风，因此她们在怀孕期间和分娩后应该密切关注血压，如果在服用含有雌激素的避孕药期间出现伴有视觉变化的偏头痛，则应咨询医生。

安德森在一封电子邮件中写道：“年轻人应该意识到，即使在青年时期和中年时期，高压力、不健康的饮食、睡眠不足和久坐的生活方式也会对中风等疾病的风险产生真实且可衡量的影响。令人遗憾的是，这种累积的风险并不需要等到退休后才会对一个人的健康造成巨大影响。”

泰勒·尼乔利是一位居住在纽约的自由撰稿人。

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