Young Strokes: Unraveling The Mystery Of Youthful Onsets

While strokes are usually associated with older people, they can and do happen to young people too. In fact, an increasing number of young and middle-aged people are experiencing strokes. There are two types of stroke: ischemic and hemorrhagic. Ischemic strokes are the most common and are caused by blood clots blocking blood flow to the brain. Hemorrhagic strokes are less common and are caused by a ruptured blood vessel in or near the brain. Young people may be at risk of strokes due to a variety of factors, including unhealthy lifestyle habits such as smoking, excessive drinking, physical inactivity, and unhealthy diets. Other risk factors include pregnancy, birth control use, and underlying health conditions such as high blood pressure, diabetes, and heart disease. It is important for young people to be aware of the warning signs of a stroke and seek immediate medical help if they experience any symptoms.

High blood pressure

In a study, stroke survivors seen at a northern California health care system during a recent 15-year period were grouped by age, ranging from 1 month to 49 years. Researchers compared traditional risk factors for stroke – high blood pressure, diabetes, smoking, obesity, and high cholesterol – among survivors and people of similar ages who did not have strokes. They found that the odds of having a stroke increased significantly as people entered their 20s, but only if they had high blood pressure or more than one risk factor.

The findings suggest that doctors need to do a better job of screening younger patients for stroke risk. People in their 20s and 30s often don't think that high blood pressure or diabetes are things they need to worry about, but these factors can significantly impact their stroke risk.

To prevent strokes, it is important to know the warning signs, which can be remembered with the acronym FAST: facial drooping, arm weakness, speech difficulties, and time to call 911. It is also important to get a wellness check, even if you think you're too young and healthy. Knowing your numbers and managing your blood pressure can help reduce your risk of stroke.

Hormonal birth control

While the overall risk of stroke related to birth control use is relatively low, some types of hormonal birth control, such as those containing estrogen, can increase the risk. According to a 2021 study, systemic hormonal contraceptives can increase the risk of stroke and heart attack by 1.6 times. This includes oral contraceptive pills and the birth control patch. The risk of stroke may be higher in people with other risk factors, such as smoking or high blood pressure.

Higher doses of estrogen are associated with a higher stroke risk. A 2019 review found that oral contraceptives with higher estrogen dosage were linked to an increased stroke risk, including both ischemic and hemorrhagic stroke. However, modern combined oral contraceptives contain a lower dose of estrogen, which reduces the risk of stroke compared to older types.

People who are using combined oral contraceptives and have other risk factors for stroke, such as smoking or high blood pressure, have a higher risk of stroke. According to a 2019 review, there may be around a 20% increased risk of ischemic stroke and total stroke with every 10 micrograms (μg) of estrogen or with each 5-year use of oral contraceptives. The risk of stroke may decrease by 20% every 5 years after stopping oral contraceptives.

The stroke risk from combined oral contraceptives is lower than the risk of stroke during pregnancy. Nonhormonal contraceptives and non-estrogen forms of birth control do not appear to increase the risk of stroke. Progestin-only birth control methods, such as progestin-only pills, implants, injections, and intrauterine devices, are not associated with an increased risk of stroke.

It is important to remember that, for most people, hormonal birth control is a safe and effective method of contraception. However, as with all medications, they can carry certain risks and side effects. Individuals should discuss their options with a healthcare professional to assess their personal risk and decide on the safest option.

Smoking

• Reduces 'good' high-density lipoprotein (HDL) cholesterol
• Increases 'bad' low-density lipoprotein (LDL) cholesterol
• Reduces oxygen levels in the blood due to the carbon monoxide in tobacco smoke
• Increases blood pressure and heart rate due to nicotine
• Makes blood thicker and more prone to clotting

The more a person smokes, the higher their risk of having a stroke. People who smoke 20 cigarettes a day are six times more likely to have a stroke than non-smokers. Those who smoke half a pack to 20 packs of cigarettes a year have a 27% higher risk, while heavy smokers (more than 40 packs per year) are three times more likely to have a stroke.

People who carry a genetic predisposition for smoking are at a 63% greater risk of having a stroke. Additionally, passive smoking increases the overall risk of stroke by 45%.

Quitting smoking can lower the risk of stroke. Within 2 years of quitting, the excess stroke risk decreases, and within 5 years, stroke risk is reduced to that of a non-smoker in most cases.

Obesity

The link between obesity and stroke is particularly concerning given the high prevalence of obesity worldwide. In the United States, obesity affects 34.9% of adults, and this trend is mirrored globally, with obesity rates nearly tripling in the past four decades. This has significant implications for the risk of stroke in young people, as maintaining a healthy weight is one of the primary ways to prevent strokes.

The relationship between obesity and stroke is complex and not fully understood. There is a theory called the "Obesity Paradox," which suggests that obese or overweight patients may have better outcomes compared to leaner individuals in certain situations. However, the evidence for this paradox in the context of stroke is conflicting and requires further research.

Overall, obesity is a significant risk factor for stroke in young people, and addressing this issue through healthy lifestyle modifications can help reduce the incidence of stroke in this population.

Cardiovascular health

Stroke is often considered a disease of older people, but an estimated 10% of stroke patients are younger than 50, and this figure is rising. In fact, between 10 and 15% of strokes occur in people aged 18 to 50, and the rate of hospitalization for stroke in this age group is increasing.

The risk factors for stroke in young people are typically different from those in older patients. While the overall rate of stroke is decreasing, especially in people over 65, it is increasing among young and middle-aged people. This is largely due to large increases in common stroke risk factors such as hypertension, lipid disorders, diabetes, tobacco use, and obesity.

Lipid disorders, or high cholesterol, are the most significant factor, increasing from about 12% to 21%. The prevalence of having three to five stroke risk factors more than doubled for women under 45.

Obesity is a major contributor to high cholesterol, high blood pressure, and diabetes—all important stroke risk factors at any age. According to the CDC, more than 42% of U.S. adults and more than 18% of U.S. children are obese.

Young people are often unaware of their cholesterol numbers and blood pressure, and tend to overlook the importance of screening for these. However, these screening tests can give physicians a good idea about stroke risk.

Hormonal birth control methods have been associated with a slightly increased risk of blood clots, which account for 87% of all strokes. Smoking also raises your risk of stroke.

It is important to note that stroke can happen at any age and to anyone. However, maintaining a healthy diet and weight can help lower your risk for type 2 diabetes, high cholesterol, and high blood pressure, which are all risk factors for stroke. Regular exercise of at least 30 minutes a day, three times a week, is also recommended.

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