Why is the age for stroke patients skewing younger?
By Deborah Jeanne Sergeant
Stroke is the fifth leading cause of death in the US and the leading cause of long-term adult disability, according to the American Heart Association.
Historically, the age of onset is usually 65-plus.
However, the Centers for Disease Control and Prevention states in an online report that prevalence among younger patients is increasing.
From 2011–13 to 2020–22, stroke jumped by 14.6% among adults aged 18 to 44 years old and by 15.7% among people aged 45 to 64 years.
Adam Kelly, board member of the American Heart Association in Western New York and professor of neurology and director of teleneurology and regional development at University of Rochester Medical Center, cited a number of reasons that could explain the increase in younger stroke patients.
“The strongest evidence points to an increase in the prevalence of typical stroke risk factors at earlier ages,” Kelly said. “We are accustomed to seeing hypertension, diabetes, high cholesterol, etcetera, develop in patients in their 50s and 60s, but the rates of these diagnosis have increased substantially in younger patients.”
The rates of obesity and sedentary lifestyle have also increased, he noted. While this is sobering news, it is important to note that people can control these factors. Kelly suggested that “lifestyle modifications, medications or other approaches and addressing these earlier in life can pay huge dividends in terms of future stroke risk.”
He added that patients can mitigate 90% of stroke risk by addressing modifiable conditions.
The CDC states that only 24.2% of adults who are currently 18 and older meet the physical activity guidelines for both aerobic and muscle-strengthening activity, compared with 31% in 2000. The National Institutes of Health states that US obesity rates have tripled over the past 60 years — and onset of obesity has shifted younger than ever.
“What we’re seeing is a shift in the timeline for things like high blood pressure, high cholesterol diabetes and smoking,” said Jonathan Donnelly, neurologist with Rochester Regional Health.
When these risk factors manifest earlier, the patient experiences higher risk for stroke earlier since the damage occurs earlier.
“By the time they get to 30 to 40, they maybe had high blood pressure for decades,” Donnelly said. “They’re in that time window earlier for when complications start to happen.”
To an extent, physicians look at other factors when younger adults experience stroke such as clotting disorders, autoimmune conditions (many of which tend to present during young adulthood) and pregnancy.
“Some changes in pregnancy can induce stroke, even up to a year after having the baby,” Donnelly added. “We still think along those lines. But someone who has stroke at 45 has the same risk factor as someone who’s 75 if they have things like high blood pressure, high cholesterol, vaping or smoking.”
One reason that younger people have stroke is that they are unaware of the risk factors and they don’t seek routine healthcare like physicals.
“People don’t go to the doctor saying, ‘I may have high blood pressure’ when they’re 30 or 40 and feeling fine,” Donnelly said. “There’s an underrecognition of things. Younger people don’t think they have to go to the doctor. They won’t go if they don’t think they have to. It can be very underrecognized in younger people because it’s not brought to anyone’s attention.”
While young, it’s easy to think that stroke is only an “old person’s” health concern and not something to worry about. However, Donnelly said that genetic factors can put people at higher risk. A study by the NIH in 2021 indicates that about half of the factors for stroke are non modifiable such as age and genetics and the other half are modifiable. Black people are at higher risk for experiencing stroke and dying from one than people of other races, for example.