Young Adults And Strokes: Understanding The Risk Factors

can young adults get a stroke

Strokes are a major cause of concern globally, and while they are more common in older adults, young adults are not exempt. In fact, the rate of strokes in young people is increasing, with research showing that 10-15% of strokes occur in adults aged 18-50. This is a worrying trend that has experts worried about the impact of lifestyle choices on the health of young people.

The risk factors for young adults are similar to those for older adults and include high blood pressure, diabetes, high cholesterol, and obesity. However, there are additional factors that are unique to younger people, such as the use of oral contraceptives, pregnancy, and drug use.

The good news is that many of these risk factors are modifiable, and young people can take steps to reduce their chances of having a stroke by making healthier lifestyle choices.

Characteristics Values
Age group 18-50
Percentage of strokes in this age group 10-15%
Risk factors High blood pressure, diabetes, high cholesterol, obesity, unhealthy lifestyle, substance use, pregnancy, genetics, etc.
Symptoms Facial drooping, difficulty speaking, loss of balance, severe headache, etc.

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Lifestyle factors

Strokes are a leading cause of death, disability, and hospitalisation, and rates among young adults are rising. While some rare conditions can predispose people to strokes at a young age, most risk factors are similar to those for older adults, including high blood pressure, diabetes, high cholesterol, and obesity. However, young adults also face unique risks related to their lifestyle, pregnancy, and genetics.

Sedentary Lifestyle

A sedentary lifestyle, with too much time spent sitting and not enough time being active, is a "silent" risk factor for strokes in young adults. Physical inactivity has been found to be a significant risk factor, with 55% of respondents in a study reporting physical inactivity, and it is recommended that young people engage in at least 150 minutes of moderate or 75 minutes of vigorous activity per week.

Substance Use

Substance use, including tobacco, nicotine, alcohol, and illicit drugs, is another risk factor. Alcohol consumption has been increasing among young adults who have had strokes, and heavy drinking and binge drinking are risk factors for high blood pressure and stroke. Alcohol may also interact negatively with medications.

Diet

An unhealthy diet is a factor in strokes, and obesity can lead to high blood pressure, high cholesterol, diabetes, and sleep apnea, all of which are risk factors for strokes.

Stress

High levels of stress or prolonged stress can lead to higher cholesterol or blood pressure and can cause narrowing of the arteries (atherosclerosis), a stroke risk factor.

Recreational Drug Use

Drugs such as amphetamines, cannabis, cocaine, heroin, and opioids increase the risk of stroke, and a stroke often occurs within hours of drug use.

Young and at Risk: Strokes in Your 50s

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Pregnancy and genetics

Pregnancy is a female-specific risk factor for stroke, with pregnancy-associated stroke (PAS) accounting for 18% of strokes in women under 35. During pregnancy, the female body undergoes significant physiological changes to adapt to the growth of the foetus and to prepare for delivery. Many of these changes may render the woman more vulnerable to thromboembolism and cardiovascular events.

Pregnancy-associated stroke is a rare event, but it leads to considerable maternal mortality and morbidity. It is estimated that 7.7-15% of all maternal deaths worldwide are caused by stroke, with 30-50% of surviving women left with persistent neurological deficits. The risk of maternal stroke is up to two to three times higher for Black, Asian and Pacific Islander, or Latinx women.

The risk of stroke is highest in the immediate peripartum period, meaning the few days around delivery and the first couple of weeks after. It gets lower and lower the further out you get from delivery. The risk is about 30 strokes per 100,000 deliveries, so it is overall a very low risk.

The other major risk factor for maternal stroke is having hypertensive disorders of pregnancy, which are very common. Hypertensive disorders of pregnancy are when you develop elevated blood pressure in pregnancy or postpartum, so conditions like gestational hypertension, preeclampsia, or eclampsia. Even a healthy pregnancy puts a lot of strain on the heart and blood vessels, so having very high blood pressure adds to the strain on your arteries, and in extreme cases can cause them to burst. This is called a haemorrhagic stroke, and is a very dangerous form of stroke that is more likely to be fatal than an ischemic stroke.

To reduce the risk of stroke during pregnancy, it is important to check your blood pressure. If it's high, there are safe medications that can lower it. In addition, in general, you can lower your risk of stroke throughout your life by staying active, exercising, stopping smoking, and eating a healthy diet such as the Mediterranean-type diet.

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Cardiovascular conditions

Young adults can experience a stroke due to cardiovascular conditions such as high blood pressure, high cholesterol, and heart disease. These conditions are becoming more prevalent among younger people. High blood pressure, in particular, is a major cause of concern as it can lead to a blocked blood vessel in the brain, resulting in an ischemic stroke. Uncontrolled high blood pressure can also cause a blood vessel to burst, leading to a hemorrhagic stroke.

In addition to these traditional risk factors, there are other factors that contribute to the increasing rate of strokes in young adults. These include:

  • Migraines: Those who experience migraines with aura are at an increased risk of ischemic stroke, especially if they are female, under the age of 45, smoke, or take oral contraceptives.
  • Pregnancy and Postpartum Period: Pregnant and postpartum women are three times more likely to experience a stroke compared to non-pregnant women of similar ages.
  • Illicit Drug Use: The use of illicit and recreational drugs is on the rise among young adults, increasing their risk of both hemorrhagic and ischemic strokes.
  • Oral Contraceptives: The use of oral contraceptive pills (OCPs) containing estrogen is associated with an elevated risk of stroke, especially when combined with smoking.
  • Hypercoagulable States: Conditions such as antiphospholipid syndrome and sickle cell disease increase the risk of blood clots and stroke.

It is important to note that the presence of these risk factors does not guarantee that a young adult will experience a stroke. However, addressing these modifiable risk factors through lifestyle changes and medical intervention can significantly reduce the likelihood of stroke occurrence.

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Migraines and headaches

A migraine usually feels like a very bad headache with a throbbing pain on one side of the head. It's common, and there are things you can try to help.

You may get other symptoms before a migraine, such as:

  • Feeling very tired and yawning a lot
  • Craving certain foods or feeling thirsty
  • Changes in your mood

You may also get warning signs that you're about to have a migraine (called an aura), such as:

  • Problems with your sight, such as seeing zigzag lines or flashing lights
  • Numbness or a tingling sensation that feels like pins and needles

Aura symptoms should not last longer than an hour.

There are different types of migraines with different symptoms:

  • Migraine without aura: warning signs like seeing zigzag lines, numbness or tingling, feeling dizzy or difficulty speaking just before the migraine starts. Symptoms like flashing lights may also be present, but no headache.
  • Migraine aura without a headache (silent migraine)

Migraines usually last between 2 hours and 3 days, with some symptoms (such as feeling very tired) starting up to 2 days before the head pain begins and finishing after the headache stops.

Some people have migraines several times a week, while others do not have them very often. It's common to have migraines before or during your period, called menstrual migraines.

Most people find their migraines slowly get better as they get older.

See a GP if:

  • Your migraines are severe or getting worse, or lasting longer than usual
  • You have migraines more than once a week
  • You're finding it difficult to control your migraines
  • You regularly get migraines before or during your period

Ask for an urgent GP appointment or get help from 111 if:

  • You have a migraine and it's lasted longer than 72 hours
  • Aura symptoms last longer than an hour at a time
  • You're pregnant or have recently given birth

Call 999 if you or your child:

  • Have a headache that came on suddenly and is extremely painful
  • Have problems speaking or remembering things
  • Lose your vision or have blurred or double vision
  • Feel drowsy or confused
  • Have a seizure or fit
  • Have a very high temperature and symptoms of meningitis
  • Cannot move or have weakness in the arms or legs on one side of your body, or one side of your face

Do not drive yourself to A&E.

Migraine treatments include:

  • Painkillers such as ibuprofen and paracetamol
  • Medicines called triptans
  • Medicines that stop you from feeling sick or being sick

You may have to try a combination of medicines before you find something that works. A GP may also recommend making changes to your lifestyle to help manage your migraines, such as eating at regular times and drinking less caffeine.

If your migraines are severe, you might be offered other treatments, such as learning relaxation techniques and acupuncture. If these treatments do not manage your migraines, you may be offered a new type of medicine called a gepant.

It is not known what causes migraines, but you're more likely to get them if you have a close family member who gets them. Some people find certain triggers can cause migraines, such as:

  • Starting their period
  • Anxiety and depression
  • Stress and tiredness
  • Not eating regularly or skipping meals
  • Not getting enough exercise

It can be helpful to keep a migraine diary to identify what might trigger your migraines.

Things you can do to ease or reduce migraines:

  • Try sleeping or lying down in a darkened room during a migraine
  • Try to avoid things you know trigger your migraines, such as certain foods
  • Stay well hydrated and limit how much caffeine and alcohol you drink
  • Try to maintain a healthy weight
  • Eat meals at regular times
  • Get regular exercise
  • Try to manage your stress

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Drug use

Stimulants like amphetamines and cocaine cause an immediate surge in blood pressure and can constrict or narrow blood vessels in the brain, reducing blood flow and causing a blockage. This can lead to both ischemic strokes and intracerebral haemorrhage.

Cocaine, in particular, can cause a sudden stroke during or immediately after use due to the quick and dramatic increase in blood pressure, which can lead to a brain bleed. Cocaine use can also cause the blood vessels in the brain to narrow or spasm, cutting off blood flow to the brain.

People who inject drugs, such as heroin, are at risk of infections that can lead to a stroke. For example, endocarditis, an infection of the heart's inner lining, can cause bacteria to enter the blood and grow over the heart valves and vessels. A clump of bacteria can then break off, travel to the brain, and block a blood vessel, resulting in a stroke.

Long-term drug use can also increase the risk of stroke. The stress on the blood vessels can cause weakening, and weakened blood vessels may rupture and cause a stroke.

It is important to note that drug use, including the misuse of prescription drugs, increases the risk of stroke, even in healthy individuals. Therefore, it is crucial for people who use drugs to be aware of the signs of a stroke and seek immediate medical attention if they experience any symptoms.

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