New Delhi: Stroke cases among young adults have nearly doubled over the past three decades, even as rates among older people have declined, according to a new study published in Neurology. Researchers found that the increase coincided with a rise in conditions such as high blood pressure, diabetes and atrial fibrillation, raising concerns about cardiovascular health among younger populations.
The study, titled ‘Stroke in the Young: Incidence, 30-Day Case Fatality Rates, and Risk Factors Over Time in a Population-Based Study’, examined stroke cases among adults aged 20 to 54 in five counties across Greater Cincinnati and Northern Kentucky in the US.
Researchers analysed six periods between 1993 and 2020, identifying 2,076 first-time strokes among younger adults. The annual incidence rate increased from approximately 34 cases per 100,000 person-years in 1993-94 to 62 cases in 2020. In comparison, the rate among adults aged 55 and older fell from approximately 619 to 453 cases.
The increase was largely driven by ischemic strokes, which occur when a blood clot blocks the flow of blood to the brain. Their incidence among younger adults nearly doubled during the study period.
What could be driving the increase?
Researchers found that hypertension, diabetes, atrial fibrillation and substance use became more common among younger stroke patients over the study period.
“The risk factors for stroke in younger adults are really the same flavors of the same risk factors that we’re seeing in older adults,” Christopher D. Anderson, chief of the stroke division at Mass General Brigham, told The Washington Post.
“It seems like they’re starting up at younger ages than historically we’ve ever really seen,” he added.
Atrial fibrillation, an irregular heartbeat, can allow blood to pool in the heart and form clots that may travel to the brain. Cardiologist Geoffrey S. Pitt told The Washington Post in a separate report that the condition causes the heart’s upper chambers to “quiver instead of maintaining coordinated pumping”. It can also go undetected: for one in five people who experience an atrial-fibrillation-related stroke, the stroke is the first indication that they have the condition.
India: one in seven stroke patients is under 45
The trend is also a concern in India. Data from the ICMR’s National Stroke Registry Programme show that 13.8 per cent of recorded stroke patients were under 45, roughly one in seven cases.
The registry led to a study that analysed 34,792 cases recorded at 30 hospitals across India between 2020 and 2022. Hypertension was the most common risk factor, affecting 74.5 per cent of patients, followed by smokeless tobacco use (28.5 per cent) and diabetes (27.3 per cent). Only 20.1 per cent of patients reached hospital within 4.5 hours of symptom onset, the window in which clot-dissolving treatment may be given to eligible patients.
The Indian figures come from hospital-based registries, while the US study tracked population-level incidence over time. They therefore cannot be directly compared, but both highlight the burden of stroke among younger adults.
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Prevention remains important
Despite the increase in incidence, the US study found that 30-day case fatality among younger stroke patients declined from 11.7% to 9.4%.
Neurologist Michelle Johansen informed The Washington Post that many strokes are preventable and that addressing risk factors earlier in life can help. Experts recommend monitoring blood pressure and cholesterol, maintaining a healthy diet, exercising and avoiding tobacco.
They also stress the importance of recognising warning signs which can be remembered via the B.E. F.A.S.T. acronym: Balance loss, Eye (vision) changes, Face drooping or twisting, Arm weakness, Speech difficulty and Time to call emergency services. Anderson urged people not to delay seeking medical attention: “Don’t try to sleep on it and come in the next day.”
(Edited by Ratan Priya)