
Strokes are often associated with old age, but they can also happen to young, healthy people. According to the CDC, about one in seven strokes occur in people aged 15 to 49. While older adults have more risk factors for strokes, such as smoking, diabetes, high cholesterol, and high blood pressure, young people may have hidden risk factors that can lead to a stroke. In this article, we will explore the risk factors and causes of strokes in healthy individuals and discuss ways to prevent them.
Characteristics | Values |
---|---|
Age | The chance of having a stroke doubles every 10 years after age 55. |
Previous strokes | Having already had a stroke or a transient ischemic attack (TIA) increases the risk of another stroke. |
High blood pressure | High blood pressure is the leading cause of strokes. |
Cholesterol | High cholesterol can lead to a buildup of cholesterol and triglycerides in the arteries, including those of the brain, which can cause a stroke. |
Heart disorders | Common heart disorders such as coronary artery disease, heart valve defects, irregular heartbeat, and enlarged heart chambers can increase the risk of a stroke. |
Diabetes | Diabetes can cause a buildup of sugars in the blood, preventing oxygen and nutrients from reaching the brain and increasing the risk of a stroke. |
Obesity | Obesity is linked to higher levels of "bad" cholesterol and triglycerides and lower levels of "good" cholesterol, which can increase the risk of a stroke. |
Sickle cell disease | Sickle cell disease is a blood disorder that can cause a stroke, particularly in Black children. |
Diet | A diet high in saturated fats, trans fat, and cholesterol is linked to an increased risk of stroke. |
Physical activity | Lack of physical activity can lead to health conditions that increase the risk of a stroke, such as obesity, high blood pressure, high cholesterol, and diabetes. |
Alcohol consumption | Excessive alcohol consumption can raise blood pressure and triglyceride levels, increasing the risk of a stroke. |
Tobacco use | Tobacco use, including smoking and secondhand smoke exposure, can damage the heart and blood vessels, increasing the risk of a stroke. |
Genetics and family history | Genetic factors can play a role in high blood pressure, stroke, and other related conditions. Strokes can also run in families due to shared tendencies for high blood pressure or diabetes. |
What You'll Learn
- High blood pressure, high cholesterol, diabetes, and obesity are common conditions that increase stroke risk
- Lifestyle choices: excessive drinking, smoking, drug use, and lack of exercise
- Genetics and family history: risk can be higher in some families than in others
- Race and ethnicity: strokes are more common in certain racial groups
- Age and gender: stroke risk increases with age and is slightly higher for men
High blood pressure, high cholesterol, diabetes, and obesity are common conditions that increase stroke risk
High blood pressure, high cholesterol, diabetes, and obesity are common conditions that increase the risk of stroke. Firstly, high blood pressure, or hypertension, is a leading cause of strokes. This is because the pressure of the blood in the arteries is too high, and there are often no symptoms. Similarly, high cholesterol levels can lead to a stroke. Cholesterol is a waxy, fat-like substance produced by the liver, and while the liver makes enough for the body's needs, we often consume more from certain foods. Excess cholesterol can build up in the arteries, including those in the brain, leading to their narrowing and, consequently, a stroke.
Diabetes is another condition that increases stroke risk. It causes sugars to build up in the blood, preventing oxygen and nutrients from reaching the brain. People with diabetes tend to develop heart disease at a younger age, and diabetes is also linked to high blood pressure and high cholesterol, which are risk factors for strokes. Obesity is also linked to higher "bad" cholesterol and triglyceride levels and lower "good" cholesterol levels. It can also lead to high blood pressure and diabetes, both of which increase the risk of stroke. Obesity is defined as having excess body fat, which can make it harder to manage diabetes and raise the risk of heart disease and high blood pressure.
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Lifestyle choices: excessive drinking, smoking, drug use, and lack of exercise
Lifestyle choices play a significant role in increasing the risk of stroke, even for healthy individuals. Here are some key lifestyle factors to consider:
Excessive Drinking
Alcohol abuse can significantly increase the risk of stroke. While light to moderate alcohol consumption may offer some protection against ischemic stroke, recent and current heavy drinking patterns elevate the likelihood of both hemorrhagic and ischemic strokes. Alcoholic cardiomyopathy, caused by excessive drinking, can lead to cardioembolic brain infarction. Additionally, cardiac arrhythmias triggered by heavy drinking or binge drinking can promote thrombus formation and the propagation of existing thrombi from the heart. Acute increases in blood pressure during alcoholic intoxication can also trigger hemorrhagic strokes. The American Heart Association recommends limiting alcohol intake to no more than two drinks per day for men and one drink per day for non-pregnant women, with pregnant women advised to abstain from alcohol entirely.
Smoking
Smoking is a major risk factor for stroke and can double the likelihood of experiencing one. It increases blood pressure and reduces oxygen in the blood, both of which are critical factors in stroke development. Tobacco smoke contains over 4000 toxic chemicals that damage the lungs and blood vessels. Smoking also makes the blood stickier, increasing the likelihood of blood clots that can lead to stroke. Continuing to smoke after a stroke significantly increases the risk of having another one.
Drug Use
The use of illegal and highly addictive substances, such as cocaine, heroin, and amphetamines, has been linked to an increased risk of stroke. These drugs can accelerate the heartbeat and elevate blood pressure, causing damage to the blood vessels in the brain. Misuse of prescription drugs, particularly those intended for pain relief (e.g., oxycodone, fentanyl) or relaxation (sedatives), is also risky. When abused, these drugs can slow down breathing and reduce the oxygen supply to the brain, creating conditions that increase the likelihood of stroke.
Lack of Exercise
Physical inactivity, particularly in older adults, is a strong risk factor for stroke. Leisure-time physical inactivity, especially in those over 80, has been associated with an increased risk of stroke. Lack of exercise can lead to other health conditions, such as obesity, high blood pressure, high cholesterol, and diabetes, which are all risk factors for stroke. Regular physical activity can help lower your chances of experiencing a stroke.
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Genetics and family history: risk can be higher in some families than in others
Genetics and family history play a significant role in stroke risk. While shared environmental factors and habits can account for the clustering of strokes in families, genetics also plays a key role.
Genetic Disorders that Cause Stroke
Single-gene disorders can directly cause strokes. These include:
- Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL): This disorder is caused by mutations in the NOTCH3 gene, leading to the accumulation of mutant Notch3 receptors in vascular smooth muscle cells. It presents with recurrent ischaemic episodes (stroke or transient ischaemic attacks) between 30 and 60 years of age.
- Cerebral Autosomal Recessive Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CARASIL): CARASIL is inherited in an autosomal recessive manner and presents with acute lumbago, spondylosis deformans, diffuse baldness, and progressive motor and mental deterioration.
- Moya-moya Disease (MMD): MMD is predominantly found in East Asian populations and has a proposed autosomal dominant pattern of inheritance with incomplete penetrance. It is characterised by intimal thickening in the walls of the terminal portions of the internal carotid vessels, often leading to cerebral ischaemia or haemorrhages.
- Fabry Disease: Fabry disease is an X-linked lysosomal storage disorder resulting from a deficiency in the α-galactosidase A enzyme. This leads to the accumulation of uncleaved glycosphingolipids in various cells, including the vascular endothelium, causing cellular dysfunction and organ failure.
- Sickle Cell Anaemia: An autosomal recessive disease resulting from a substitution in the β-chain of haemoglobin, causing red blood cells to adopt a "sickle" shape and obstruct blood vessels. Sickle cell anaemia is the most common cause of stroke in children.
- Homocystinuria: A group of inherited conditions characterised by defective methionine metabolism due to a deficiency in the cystathione β-synthase enzyme. This results in elevated homocysteine levels, causing endothelial dysfunction and promoting smooth muscle cell proliferation, leading to stroke.
- Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke (MELAS): A progressive neurodegenerative disorder caused by mutations in mitochondrial DNA. The exact pathogenesis is unclear, but it may involve mitochondrial angiopathies of vessels or mitochondrial dysfunction in the brain parenchyma.
- Marfan Syndrome: A multisystem disorder of connective tissue caused by mutations in the fibrillin 1 gene. Neurovascular complications are rare but can include TIAs, cerebral infarctions, spinal cord infarctions, and subdural haematomas.
- Ehlers-Danlos Syndrome Type IV: An autosomal dominant condition resulting from mutations in the gene for type III procollagen. It leads to defective collagen formation, causing fragile arteries and intestines prone to rupture. Neurovascular complications occur in about 10% of patients.
Genetic Disorders that Increase Stroke Risk
Some genetic disorders primarily cause other symptoms but can increase the risk of stroke. These include:
- Blood Disorders: Antiphospholipid syndrome (Hughes syndrome) and factor V Leiden thrombophilia.
- Blood Vessel Disorders: Fibromuscular dysplasia, giant cell (or temporal) arteritis, and hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome).
- Metabolic Disorders: Cerebrotendinous xanthomatosis and MELAS.
- Connective Tissue Disorders: Ehlers-Danlos syndrome.
Polygenic Disorders and Stroke
Most cases of stroke are multifactorial or polygenic in nature, influenced by multiple genetic variants, each conferring a small relative risk. Candidate gene and case-control studies have been used to investigate these genetic predispositions, but large sample sizes are necessary due to the small effect sizes of individual genes.
A Practical Approach to Managing Young Stroke Patients
When presented with a young individual who has suffered a stroke, it is essential to consider both common and rare aetiologies. In addition to a detailed history and examination, initial investigations should include blood tests, a computed tomographic scan of the head, and, if there is a personal or family history of thrombosis, a more detailed coagulation profile. Further tests may include a pregnancy test, chest x-ray, electrocardiogram, echocardiogram, and extracranial Doppler ultrasound.
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Race and ethnicity: strokes are more common in certain racial groups
Race and ethnicity play a significant role in stroke prevalence, with certain racial groups facing higher risks. According to the Office of Minority Health, Black men in the United States have a 50% higher risk of stroke than white men and are 70% more likely to succumb to the condition. Similarly, Black women are twice as likely to experience a stroke compared to white women and face a 30% higher risk of death from the condition. This disparity in stroke occurrence and outcomes is influenced by a combination of factors, including underlying health conditions, lifestyle choices, social determinants, and genetic factors.
Underlying health conditions, such as high blood pressure, obesity, diabetes, untreated sleep disorders, high cholesterol, carotid artery disease, peripheral artery disease, atrial fibrillation, and other heart diseases, are more prevalent among Black Americans and contribute to their elevated stroke risk. Additionally, sickle cell anemia, a genetic condition that affects blood cell shape and flow, is much more common among African Americans and increases their susceptibility to stroke.
Lifestyle choices also play a role in stroke risk among racial groups. For example, according to the American Lung Association, African American men smoke more than men from any other racial group, and smoking doubles the risk of stroke for Black individuals. Dietary habits, such as excessive salt intake, further contribute to high blood pressure and stroke risk in the Black community.
Social determinants of health, including economic and job stability, access to transportation, healthcare access and quality, neighborhood poverty, and educational level, also influence stroke risk among racial groups. These factors can affect an individual's ability to manage their health and access necessary preventative care.
Finally, genetic differences between people of African and European ancestry may also contribute to the disparity in stroke prevalence. However, more research is needed to fully understand the role of genetics in stroke risk among different racial groups.
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Age and gender: stroke risk increases with age and is slightly higher for men
While anyone can have a stroke at any age, the risk of having a stroke increases as you get older. According to the CDC, the chance of having a stroke roughly doubles every 10 years after the age of 55. The average age of a stroke patient is in their 70s. However, it's important to note that strokes can and do occur in younger people as well. About one in seven strokes occur in adolescents and young adults aged 15 to 49.
The risk of stroke is slightly higher for men than for women of the same age. However, women tend to have strokes at an older age, which makes them less likely to recover and more likely to die as a result. Pregnancy and the use of birth control pills are also associated with an increased risk of stroke in women.
Age is a significant factor in the development of stroke risk factors. As we age, our arteries become harder and narrower, making them more susceptible to blockage. This, combined with other risk factors such as high blood pressure, high cholesterol, and diabetes, further increases the chances of having a stroke.
While age and gender are factors that cannot be controlled, understanding their impact on stroke risk is crucial for taking preventive measures. Regular check-ups, especially after the age of 40, can help identify any problems and manage risk factors effectively.
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