Yury Trafimovich
Strokes and heart attacks are becoming increasingly common among younger people. In the US, the rate of strokes has been steadily rising among Americans younger than 49 for the past 30 years. Similarly, there has been an alarming increase in heart attacks for people under 40. So, what's causing this worrying trend? A range of factors are contributing to this rise, including stress, COVID, lifestyle, and diet. Unhealthy lifestyle choices such as poor diet, limited exercise, smoking, and excessive alcohol consumption are major risk factors. Additionally, underlying health conditions such as high blood pressure, diabetes, high cholesterol, and obesity are also playing a significant role. These conditions are becoming more prevalent among younger people, increasing their risk of experiencing a stroke or heart attack.
| Characteristics | Values |
|---|---|
| Age group | 18-44 years; 45-64 years |
| Gender | More common in women |
| Geography | Faster rate of increase in the South, West and Midwest of the US |
| Ethnicity | Higher rates in populations of African, Hispanic, and East Asian descent |
| Lifestyle | Sedentary lifestyle, substance use, poor diet, limited exercise, smoking, overconsumption of alcohol |
| Health conditions | High blood pressure, diabetes, high cholesterol, obesity, hypertension, high blood sugar |
What You'll Learn
Unhealthy lifestyle choices
Sedentary lifestyles and a lack of physical activity, particularly cardiovascular exercise, are also contributing factors. Spending excessive time sitting in front of a computer screen or being inactive can increase the likelihood of these health issues. Additionally, unhealthy lifestyle choices often begin at a young age, with children engaging in limited physical activity and consuming unhealthy foods, setting them on a path toward increased risk in adulthood.
Smoking and substance use, including tobacco, nicotine, and illicit drugs, further elevate the chances of cardiovascular events. Smoking increases blood pressure, reduces oxygen in the blood, and contributes to the buildup of plaque in arteries, making it harder for blood to flow smoothly. Substance abuse, including the use of marijuana and cocaine, has been linked to an increased risk of heart attacks among younger individuals.
It is important to note that these unhealthy lifestyle choices are modifiable risk factors. By making conscious decisions to improve dietary habits, increase physical activity, manage stress, and quit smoking, individuals can significantly reduce their chances of experiencing strokes or heart attacks at a young age.
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Genetic conditions
Genetics plays a significant role in the increasing incidence of strokes and heart attacks among younger individuals. Genetic variations passed down from parents to children can increase the likelihood of developing heart disease and related complications. These genetic predispositions, combined with other risk factors, contribute to the rising trend of cardiovascular events in younger populations.
Inherited Cardiac Conditions
Several cardiac disorders have a strong genetic component and can be inherited, including arrhythmias, congenital heart disease, cardiomyopathy, and high blood cholesterol. These conditions can increase the risk of heart attacks and strokes, even at a young age. For example, congenital heart disease, which encompasses structural abnormalities and irregular heart rhythms, is a known risk factor for strokes.
Genetic Influence on Cardiovascular System
Genes govern every aspect of the cardiovascular system, from the strength and integrity of blood vessels to the intricate communication between heart cells. A genetic variation or mutation in a single gene can disrupt normal cardiovascular functioning and increase the susceptibility to heart disease. For instance, a genetic variation can alter how the body processes cholesterol, leading to an increased risk of blocked arteries.
Inherited Heart Diseases
There are two types of inherited heart diseases: those caused by multiple subtle genetic changes that collectively contribute to disease development and those resulting from one or a few genetic changes with a strong effect. Inherited cardiomyopathies, such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC), affect the heart muscle. On the other hand, inherited arrhythmias, including Long QT Syndrome and Brugada Syndrome, disrupt the electrical system of the heart, leading to abnormal heart rhythms.
Genetic Testing
Genetic testing plays a crucial role in diagnosing and predicting inherited heart diseases. It involves analyzing an individual's DNA to identify pathogenic mutations that are known to cause specific heart conditions. This testing is particularly recommended for family members of individuals who have experienced sudden cardiac death or have been diagnosed with an inherited heart condition. Genetic testing can clarify diagnoses, identify at-risk family members, and guide family planning decisions.
Modifying Risk Factors
While genetics is a significant factor, it is essential to recognize that managing risk factors can help prevent strokes and heart attacks in younger individuals. Adopting a healthy lifestyle, including a nutritious diet, regular exercise, and adequate sleep, can mitigate the impact of genetic predispositions. Additionally, regular medical check-ups and early intervention can significantly reduce the likelihood of cardiovascular events in those with known genetic conditions.
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Cardiovascular issues
Sedentary lifestyles, unhealthy diets, and stress are major contributors to the increase in strokes and heart attacks among younger people. These factors lead to high blood pressure, diabetes, high cholesterol, and obesity, which are common risk factors for both strokes and heart attacks.
Strokes
Strokes occur when blood vessels carrying oxygen and nutrients to the brain are blocked or ruptured, often due to clots. Ischemic strokes, caused by blocked vessels, account for about 87% of all strokes and 60% in people under 50 in the United States. However, the increase in strokes among younger individuals has medical professionals concerned that strokes are not solely an issue for older adults.
Research shows a concerning rise in stroke cases among younger individuals. The American Heart Association's data reveals a 43% increase in stroke rates among 45- to 54-year-olds and a 36% increase in the 18- to 34-year-old age group between 2003 and 2012. Additionally, the number of young adults experiencing strokes in northern Colorado has nearly doubled in recent years, with 9% of stroke patients at UCHealth Poudre Valley Hospital falling between the ages of 18 and 45 in July 2023, up from 5% in 2020.
While rare conditions can predispose individuals to strokes at a young age, most risk factors are similar to those in older adults, including high blood pressure, diabetes, high cholesterol, and obesity. These conditions are becoming increasingly prevalent among younger people. Additionally, "silent" risk factors such as a sedentary lifestyle and substance use further contribute to the rise in strokes among this age group.
Heart Attacks
Heart attacks, once considered a concern primarily for older individuals, are now occurring more frequently in younger people. A study of over 1.4 million young adults hospitalized for heart attacks found that 92% had at least one modifiable risk factor, including high blood pressure, smoking, obesity, diabetes, and high cholesterol.
Lifestyle changes, such as increased screen time, consumption of ultra-processed foods, and decreased physical activity, particularly cardio, are significant contributors to the rise in heart attacks among younger people. Type 2 diabetes, which has seen a spike in younger individuals, is one of the biggest risk factors for heart disease, doubling the risk. Elevated blood sugar levels from diabetes can damage blood vessels and nerves serving the heart, leading to coronary artery disease and interrupting blood flow to the heart.
Substance abuse, particularly the use of marijuana and cocaine, has also been identified as a risk factor specific to younger individuals experiencing heart attacks.
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Undiagnosed conditions
Inherited Conditions
Certain genetic disorders can elevate the likelihood of experiencing a stroke or heart attack at a young age. These inherited conditions can include:
- Congenital heart disease: Structural abnormalities or irregular heart rhythms stemming from genetic factors can increase the risk of stroke.
- Blood clotting disorders: Conditions that enhance the tendency of blood to clot while circulating through the body, such as sickle cell disease, can lead to stroke or heart attack.
- Metabolic conditions: Disorders like Fabry disease can cause various issues, including narrowing of blood vessels supplying blood to the brain, high blood pressure, or abnormal cholesterol levels, all of which increase the risk of stroke.
Acquired Conditions
In addition to inherited conditions, certain acquired or lifestyle-related factors can also increase the risk of strokes and heart attacks in younger people:
- High blood pressure (hypertension): This is a significant risk factor for both strokes and heart attacks. It can be caused by various factors, including obesity, diabetes, and excessive alcohol consumption.
- High cholesterol: High cholesterol levels can lead to plaque buildup in the arteries, increasing the risk of blockage and causing a stroke or heart attack.
- Obesity: Being overweight is a crucial risk factor for cardiovascular diseases, including strokes and heart attacks.
- Smoking: Cigarette smoking increases blood pressure, reduces oxygen in the blood, and contributes to plaque buildup in the arteries.
- Substance use: Illicit drug use and excessive alcohol consumption can increase the risk of both strokes and heart attacks.
- Sedentary lifestyle: Spending too much time sitting, whether in front of a computer screen or not being sufficiently active, can contribute to the risk of cardiovascular events.
The Role of Prevention and Early Diagnosis
The impact of undiagnosed conditions on the increasing incidence of strokes and heart attacks in younger people underscores the importance of prevention and early diagnosis. Young individuals should not assume that they are exempt from these health issues due to their age. Knowing the warning signs and risk factors is crucial, as it can enable early intervention and potentially prevent long-term disabilities.
Additionally, addressing modifiable risk factors through lifestyle changes, such as improving diet, increasing physical activity, quitting smoking, and managing stress, can significantly reduce the likelihood of experiencing a stroke or heart attack at a young age.
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Stress and substance abuse
Stress
Stress can have detrimental effects on cardiovascular health, increasing the risk of heart attacks and strokes. Managing stress is crucial for maintaining a healthy heart and brain. High-stress levels can elevate blood pressure and cause hypertension, a significant risk factor for cardiovascular diseases, including strokes.
Substance Abuse
Substance abuse, particularly the use of illegal and highly addictive substances, has been linked to an increased risk of strokes and heart attacks in younger individuals. This includes the use of stimulants such as amphetamines, cocaine, and phencyclidine, which can cause elevated blood pressure and vasospasm, leading to potential blockages and ruptures in blood vessels supplying the brain.
The misuse of prescription drugs, especially painkillers and sedatives, can also increase the risk of stroke. Additionally, the use of substances like heroin and cocaine has been associated with infectious complications, such as endocarditis and ruptured aneurysms, which can lead to strokes.
Furthermore, cannabis use, although controversial, has been suggested to increase the risk of ischemic stroke and intracerebral hemorrhage. While the link between cannabis and stroke requires further research, it is important to consider it as a potential risk factor, especially with the increasing legalization and accessibility of cannabis.
Substance abuse and addiction can have severe consequences for cardiovascular health, and it is essential to seek professional help to overcome these issues.
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Frequently asked questions
There are several factors contributing to the rise in strokes and heart attacks in young people. These include unhealthy lifestyle choices such as poor diet, limited exercise, smoking, and overconsumption of alcohol. Additionally, stress, COVID, and the overconsumption of ultra-processed foods and fast food have been identified as contributing factors.
It is important to be able to recognise the signs of a stroke, as quick treatment increases the chances of preserving brain tissue and reducing long-term deficits. A helpful acronym to remember is BE FAST or FAST:
- Balance: A sudden loss of balance or coordination.
- Eyes: Sudden vision loss or double vision.
- Face: Drooping or uneven smile on one side of the face.
- Arms: Sudden weakness in one arm or leg.
- Speech: Slurred speech or difficulty speaking or understanding words.
- Time: Call emergency services immediately if you experience any of these symptoms.
There are several modifiable risk factors for strokes and heart attacks, including high blood pressure, smoking, obesity, diabetes, and high cholesterol. Other factors such as substance use, sedentary lifestyle, and genetic conditions can also increase the risk of these cardiovascular events.
Preventing strokes and heart attacks in young people involves addressing the underlying risk factors. This can include making healthier lifestyle choices, such as improving diet, increasing physical activity, reducing stress, and quitting smoking. It is also important for young people to be aware of their family history and to discuss any potential risk factors with their healthcare provider.
Strokes and heart attacks can have serious long-term effects, including disabilities and long-term therapies. In some cases, 24-hour skilled nursing care may be required. It is important to seek medical attention as soon as possible to minimise the potential damage caused by these events.
