Strokes: Young Victims And Their Plight

Strokes are often thought to be an older person's problem, but they can happen to anyone of any age. In fact, according to the American Heart Association, incidents of stroke have increased by 40% among young US adults over the past few decades, with approximately 10-15% of strokes occurring in adults aged 18-50. This worrying trend has been attributed to a range of factors, including unhealthy lifestyle choices, stress, COVID, and genetics.

Young people face unique risks specific to lifestyle, pregnancy, and genetics, in addition to typical risk factors such as high blood pressure, blood clots, and diabetes. Other factors that can increase the risk of stroke in younger patients include birth control pills containing estrogen, blood clotting disorders, cocaine or other drug use, migraine with aura, patent foramen ovale (a hole in the heart), pregnancy and the postpartum period, sedentary lifestyle, and sickle cell disease.

The good news is that young people tend to recover faster from strokes because they are generally in better physical shape and have more neurological reserve to draw upon after a brain injury. However, the impact of a stroke on a young person's life can be devastating, disrupting careers and causing financial hardship. It is crucial to recognize the signs of a stroke and act quickly to improve the chances of a full recovery.

Lifestyle factors: smoking, drinking, obesity, poor diet, lack of exercise

Lifestyle factors such as smoking, drinking, obesity, poor diet, and lack of exercise are major contributors to strokes in young people. These factors can lead to an increased risk of stroke by weakening or damaging the arteries, causing clots to form, and increasing blood pressure.

Smoking

Cigarette smoking is a well-established risk factor for all forms of stroke and is the single most preventable cause of mortality in society today. The risk of stroke increases with the amount smoked and the duration of smoking. In addition to the health risks, smoking is also financially costly to individuals in the form of increased taxes and insurance rates, and lost wages. Quitting smoking is one of the most important things a person can do to reduce their risk of stroke.

Drinking

Excessive alcohol consumption can lead to hypertension, atrial fibrillation, diabetes, overweight, and liver disease, all of which increase the risk of stroke. It is important to track alcohol intake and make conscious efforts to reduce consumption, such as having alcohol-free days and replacing alcoholic drinks with low or no-alcohol alternatives.

Obesity

Obesity is a significant risk factor for developing cardiovascular diseases, including stroke, and is associated with an increased risk of ischemic stroke in young adults. The association between obesity and stroke may be partially mediated through hypertension and diabetes mellitus, which are conditions that are commonly associated with obesity.

Poor diet and lack of exercise

Unhealthy eating habits and a lack of physical activity can contribute to weight gain and increase the risk of high blood pressure, high cholesterol, and other cardiovascular diseases. Adopting a healthy diet and engaging in regular exercise are important for maintaining cardiovascular health and reducing the risk of stroke.

Pregnancy and genetics

Pregnancy increases the risk of stroke, especially in women with pre-existing or gestational hypertension, diabetes, valvular heart disease, hypercoagulable disorders, sickle cell disease, lupus, substance abuse, and migraines.

Pregnancy is associated with a prothrombotic state, which, when combined with dehydration or an underlying predisposition for thrombophilia, can lead to both ischemic and hemorrhagic strokes.

Pregnancy is also associated with physiological changes that may increase the risk of hemorrhagic infarctions, such as increased total body water, increased cardiac output, stroke volume, and heart rate, decreased blood pressure, and increased venous compliance and venous stasis.

Genetics play a role in stroke risk, with research suggesting that 15-52% of people who have a stroke have a family member who has also had a stroke. The risk of stroke may be 36-44% higher if you have a parent or sibling who has had a stroke.

Genetic factors that increase the risk of stroke include:

• Genetic disorders that primarily cause stroke, such as CADASIL, CARASIL, and familial amyloid angiopathy.
• Genetic disorders that include stroke as a complication, such as antiphospholipid syndrome, factor V Leiden thrombophilia, fibromuscular dysplasia, and Ehlers-Danlos syndrome.
• Genetic mutations that increase the risk of stroke, such as those that cause hypertension or diabetes.
• Genetic mutations that cause stroke risk factors, such as hypertension or diabetes.

COVID-19

Firstly, it is believed that the SARS-CoV-2 virus induces inflammation throughout the body, including in the walls of blood vessels. This inflammation can lead to the thickening of the blood and the formation of blood clots, which can then travel to the brain and cause a stroke. In support of this theory, doctors have observed an increase in major strokes among COVID-19 patients in New York City, with these new stroke patients being "substantially younger" than the typical stroke patient.

Another hypothesis suggests that the virus may bind to receptors on endothelial cells, which line the inside of blood vessels. This could trigger an immune reaction, resulting in clotting and potentially causing a stroke if the clots reach the brain. This theory is also supported by clinical observations, as COVID-19 patients with strokes tended to be older and had more severe COVID-19 symptoms.

The link between COVID-19 and strokes in young people is a concerning complication of the virus. While the overall risk of stroke in COVID-19 patients is still considered low, it is important for individuals to be aware of the symptoms of a stroke and seek immediate medical attention if they suspect they or someone around them is experiencing one. Recognising the signs early on is crucial, as timely treatment can significantly improve the chances of recovery and prevent permanent disability.

To conclude, while the relationship between COVID-19 and strokes in young people is not yet fully understood, the available evidence suggests that the virus may increase the risk of strokes, even in otherwise healthy individuals. Further research is needed to confirm these findings and develop effective preventive measures and treatments.

High blood pressure

Risk Factors

Young adults with high blood pressure are at a significantly increased risk of stroke. This risk grows as people move from their 20s into their 30s and 40s. Having any one additional risk factor, such as obesity, smoking, or diabetes, also significantly increases the chances of having a stroke.

Prevention and Treatment

To prevent strokes, it is important to control high blood pressure through lifestyle changes or medication. Regular exercise, maintaining a healthy weight, and moderating alcohol consumption can all help to lower blood pressure.

Racial Disparities

It is important to note that Black and Hispanic patients are at a higher risk of stroke and are more likely to have uncontrolled hypertension. Therefore, early diagnosis and sustained control of high blood pressure are critical in these communities.

Diabetes

Hyperglycaemia, or high blood sugar, is a common phenomenon presented in the early acute stroke phase. It may be related to a non-fasting state and stress reaction with impaired glucose metabolism. The initial level of plasma glucose is highly correlated with poor post-stroke outcomes. Acute hyperglycaemia increases brain lactate production, reduces salvage of penumbral tissue and causes greater final infarct size.

There are several possible mechanisms by which diabetes leads to stroke. These include vascular endothelial dysfunction, increased early-age arterial stiffness, systemic inflammation and thickening of the capillary basal membrane.

To prevent stroke, people with diabetes should manage blood glucose, blood pressure, cholesterol and weight. Controlling diabetes and other associated risk factors are effective ways to prevent initial strokes as well as stroke recurrence.

• Check your blood glucose level often and take steps to keep it within a healthy range (less than 140 mg/dL).
• Check your blood pressure regularly and report problems to your healthcare team.
• Eat a nutritious, balanced diet to lower cholesterol and maintain a healthy weight.
• Get enough sleep to maintain health and energy.
• Keep all of your medical appointments.
• Limit salt in your diet to help regulate blood pressure.
• Maintain a weight that’s healthy for you and lose belly fat.
• Quit smoking and/or using tobacco products.
• Take all of your medications exactly as prescribed.

Frequently asked questions