Stroke Risk: Can Healthy People Suffer Too?

can someone healthy have a stroke

Strokes are often associated with older people, but this is a misconception. While it's true that the risk of having a stroke increases with age, young, healthy people can also have strokes. In fact, about one in seven strokes occur in people aged 15 to 49, and certain health conditions can cause strokes in younger individuals.

Characteristics Values
Age Age is one of the biggest risk factors for strokes, but anyone of any age can have a stroke. Strokes are rare in young people, but about one in seven strokes are in people aged 15 to 49.
Lifestyle Lifestyle choices such as smoking, drinking alcohol excessively, and using drugs can increase the risk of having a stroke.
Medical Conditions People with high blood pressure, high cholesterol, or diabetes are more likely to have a stroke. Other medical conditions that can increase the risk of stroke include heart conditions, blood clotting disorders, polycystic kidney disease, and migraine.
Genetics Genes play a significant role in the risk of having a stroke, and it can run in families. Some people are born with blood vessel malformations or defects that increase the risk of stroke.
Stress and Caffeine There is mixed evidence about the impact of caffeine consumption, but stress can raise blood pressure enough to cause a stroke.

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Genes and family history

Genetics researchers are increasingly connecting specific, inherited gene mutations with the likelihood of having a stroke. While stroke has long been considered a disease of old age and a random event that’s hard to predict, recent large-scale studies have highlighted the role of genetics in stroke risk. Identifying gene mutations linked to stroke may lead to better stroke prevention, treatment, and recovery.

Gene Mutations and Stroke Risk

First, a quick genetics lesson: “Alleles” are variations, or mutations, of a gene that are found on a chromosome. Most genetic mutations, inherited from your parents, do no harm, but some increase your risk of disease, including stroke. Their presence is often linked with conditions that can lead to stroke. For example, in 2021, German researchers studied nearly 900,000 people and linked genes for diabetes and high blood sugar with stroke.

Genetic Connection and Stroke Assessment

A larger study, published in the journal Nature, looked at more than 1.5 million people and identified 89 genes that are associated with stroke. Studies like this could be game-changing, allowing for the development of new therapies to mitigate stroke risk. Although still in the research stages, these findings might change the future of stroke risk assessment, prevention, and treatment.

Genes and High Blood Pressure

Several of the genes identified in the Nature study have an effect on blood pressure. This knowledge may help develop new and targeted treatments for high blood pressure, or hypertension, which is a major risk factor for stroke. That’s important because many people have hypertension that does not respond well to currently available treatments.

Genes and Higher Stroke Risk in Black Americans

Black people in the U.S are 50% more likely to have a stroke than white Americans. One of the reasons: High blood pressure is much more common in the Black community. Genetics may explain part of that difference, and the new research may help confirm that.

Custom Genetic Therapy

This type of genetic research also may allow for the development of therapies for people with certain genes. Therapies could potentially be more individualized to a patient’s specific genetics—an emerging concept and field called precision medicine, or personalized medicine. This concept has been studied and used more recently in cancer therapies, with the development of drugs targeted at the specific genetic makeup of a cancer, which can vary from individual to individual. Now, perhaps, the same principles can be applied to stroke.

Power in Numbers

Dr. Jason Hinman, a neurologist and stroke researcher, explains that technical advances in recent years have allowed researchers to conduct large genetic studies. Rather than looking at just a few hundred people, such studies feature a few hundred thousand—or more. “That becomes a really powerful tool,” he says. It’s early days, but he predicts that genetic tests eventually will be available that will be able to identify at-risk patients.

Family History

Stroke genetics is a developing field. However, even though specific stroke-linked genes have been discovered only recently, experts have long known that family health history plays a significant role in stroke. Do stroke risk factors like high blood pressure, diabetes, high cholesterol, obesity, or heart disease run in your family? If so, you may be more likely to develop the same risk factors. Another less-common risk factor: a family history of brain aneurysms, especially when accompanied by kidney disease.

What to Ask About Your Family History

Share a thorough review of the health problems that your siblings, parents, and grandparents have now, or have had in the past with your doctor, who can look for suspicious patterns that may indicate higher risk of stroke. For example, if your grandmother had a stroke at 80, your mother at 70, and you at 60, that decreasing age may point to a genetic syndrome that runs in your family.

Gene Expression and Lifestyle

Keep in mind that family history encompasses more than genes. It also means your environment. Did you grow up in a household with cigarette smoke? Did you eat an unhealthy diet and get little exercise? You may have developed such habits as an adult, as well. We know that certain behaviors, such as sedentary lifestyle and smoking, are linked with stroke risk. However, your environment, behaviors, and lifestyle factors also alter how your genes are expressed and thereby impact your health, including stroke risk.

Manage Your Specific Stroke Risk

What can you do to protect yourself if you have a family history of stroke? “There’s a critical role for managing your other risk factors,” says Dr. Hinman. “You definitely want your blood pressure, your diabetes, and other things that can be controlled to be as tightly controlled as they can be.” He also recommends that you consult a stroke neurologist, who can follow you on an annual or biannual basis. “That’s critical to make sure you’re doing what you can to reduce your non-heritable risk,” he adds.

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Lifestyle choices

Smoking

Smoking is a significant risk factor for strokes, as it can lead to atherosclerosis, which is plaque buildup in the arteries. This condition is typically not found in young people but is more common in older adults. However, smoking can increase the risk of stroke at any age.

Alcohol Consumption

Excessive alcohol consumption is another risky lifestyle choice that can increase the likelihood of having a stroke. Drinking alcohol excessively can raise blood pressure and contribute to other health conditions that are risk factors for stroke. It is recommended to drink within the recommended limits to reduce stroke risk.

Drug Use

Using drugs, especially intravenous (IV) drug use, can increase the risk of stroke. IV drug use can lead to endocarditis, an infection that affects the heart's lining, heart valves, or blood vessels. This, in turn, can increase the likelihood of experiencing a stroke.

Diet and Weight

Unhealthy dietary habits and carrying excess weight, especially around the belly, can contribute to risk factors for stroke, such as high cholesterol, high blood pressure, and diabetes. Maintaining a healthy weight and eating a well-balanced diet can help reduce these risk factors.

Physical Activity

Regular physical activity is essential for maintaining a healthy weight and overall health. Lack of exercise can increase the risk of stroke, especially when combined with other unhealthy lifestyle choices. Staying physically active can help lower blood pressure and improve overall cardiovascular health, reducing the chances of having a stroke.

While it is important to adopt healthy lifestyle habits, it is also crucial to understand that stroke risk is multifaceted and influenced by various factors, including age, genetics, and underlying health conditions. Some people with healthy lifestyles may still experience a stroke, while others with less healthy habits may not. However, making positive lifestyle choices can significantly reduce the odds of having a stroke.

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Blood clots

There are two types of blood clots that can cause ischemic strokes:

  • Thrombotic strokes, which occur when a blood clot forms in the brain. This is called thrombosis, and it happens when fatty deposits called plaque line the vessel walls.
  • Embolic strokes, which occur when a clot called an embolism forms elsewhere in the body and travels to the brain, getting stuck in a blood vessel. This can happen due to an irregular heartbeat called atrial fibrillation, which causes clots to form in the heart and travel to the brain.

Other risk factors for blood clots leading to stroke include:

  • Heart and blood conditions such as coronary heart disease, atrial fibrillation, heart valve disease, and carotid artery disease.
  • Atherosclerosis, or the buildup of fatty deposits on the inner walls of arteries, causing them to harden and narrow.
  • High blood pressure, which is a shared risk factor for both ischemic and hemorrhagic strokes.
  • Lifestyle factors such as smoking, alcohol consumption, and the use of recreational drugs.
  • Health conditions such as high cholesterol, diabetes, and alcohol use disorder.

It is important to recognize the warning signs of a stroke and seek immediate medical attention. The acronym BE FAST can help identify stroke symptoms:

  • Balance: Watch for a sudden loss of balance.
  • Eyes: Look for sudden vision loss or changes in one or both eyes.
  • Face: Smile and check for a droop on one or both sides of the face.
  • Arms: Raise both arms; if one arm sags or drops, it could be a sign of a stroke.
  • Speech: Slurred speech or difficulty finding the right words may indicate a stroke.
  • Time: Time is critical; call for emergency services immediately if you suspect a stroke.

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High blood pressure

The body repairs these tears with scar tissue, but this scar tissue can then lead to blockages, blood clots, and hardened, weakened arteries. High blood pressure damages arteries throughout the body, creating conditions that can make them burst or clog easily. Weakened or blocked arteries in the brain create a much higher risk for stroke. This is why managing high blood pressure is critical to reducing your risk of stroke.

Several factors can increase your risk of high blood pressure, including family history, age, lack of physical activity, poor diet, obesity, and drinking too much alcohol. It is important to regularly check your blood pressure, as high blood pressure often has no apparent symptoms, and many people don't know they have it.

To reduce your blood pressure, you should eat a healthy diet, including reducing salt intake, engage in regular physical activity, maintain a healthy weight, avoid tobacco smoke, take prescribed medication, and limit your alcohol consumption.

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Heart conditions

The most prevalent heart problems witnessed in stroke patients include myocardial infarction (heart attack), heart failure, and cardiac arrhythmias, particularly atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. These heart conditions are often associated with the same underlying processes that cause strokes, most commonly thrombosis (blockage) of an artery. In other cases, the heart problem itself may trigger a stroke, as seen with atrial fibrillation, which can produce an embolus in the brain.

Additionally, atherosclerosis, a narrowing and disease of the arteries that makes them susceptible to blockages, is frequently implicated in strokes. This condition can lead to coronary artery disease (CAD) and, subsequently, a heart attack. Atherosclerosis can also contribute to acute blockages in other vessels, leading to both heart attacks and strokes.

It is crucial to recognize that heart problems can emerge after a stroke as well. A stroke can precipitate a dramatic increase in adrenaline levels and other hormones, which can impair the function of the heart muscle and lead to cardiac ischemia, even in individuals without CAD. This neurologically-mediated cardiac ischemia often results in permanent heart damage and is commonly observed in young, healthy people who experience a stroke due to subarachnoid hemorrhage.

Furthermore, strokes are associated with "cardiac stunning," where a portion of the heart muscle suddenly stops functioning normally, resulting in severe but temporary heart failure. If a stroke occurs alongside myocardial infarction, it can further exacerbate the situation and lead to heart failure.

In summary, while heart conditions are a significant factor in strokes, it is important to recognize that they can also develop as a result of a stroke or during the recovery phase. Therefore, anyone who has experienced a stroke should be carefully monitored for heart complications and take the necessary steps to reduce the risk of future cardiac issues and recurrent strokes.

Frequently asked questions

Yes, strokes can occur in young, healthy people. According to the CDC, about one in seven strokes occur in people aged 15 to 49. While older people are often thought of as the "typical" stroke patient, a quarter of strokes in the UK are in people under 65, and there are even cases of childhood strokes.

There are several causes of strokes in young, healthy people, including:

- Defects in blood vessels that have been present from birth, such as arteriovenous malformation, which can rupture and cause a bleed in the brain.

- Sudden peaks in blood pressure, especially if the person already has high blood pressure.

- Stress, which can raise blood pressure enough to cause a stroke.

- Irregular heartbeat, or atrial fibrillation, which can lead to blood clots that travel to the brain.

- Genetic factors, as some people are simply more likely to have a stroke due to their family history.

While anyone can have a stroke, there are several lifestyle changes you can make to reduce your risk:

- Drink alcohol within the recommended limits.

- Stay a healthy weight.

- Don't smoke.

- Eat a well-balanced diet.

- Stay physically active.

- Get regular check-ups, especially if you are over 40.

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