Young adults are more likely to have strokes now than they were in the early 1990s, a new study suggests. The study covered only the greater Cincinnati area, including northern Kentucky. But experts said the trend likely applies nationwide, too. Researchers looked at first-time strokes that occurred between 1993 and 2005. In the first year, people ages 20 to 54 had 13% of the strokes. By 2005, that had jumped to 19%. Stroke rates varied by race. However, increases occurred across all groups. For example, the annual stroke rate for young blacks increased from 83 to 128 per 100,000 people. Among young whites, the rate rose from 26 to 48 strokes per 100,000 people. Better diagnosis could be one reason. Magnetic resonance imaging (MRI) is more widely used now. MRI scans may have uncovered more mild strokes. But researchers and other experts said the most likely reason is the increase in obesity and diabetes among younger adults. Both trends increase people's risk of stroke. The journal Neurology published the study online October 10. HealthDay News and Reuters Health news service wrote about it.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Do you think of certain diseases as limited to the elderly?

If you do, it's understandable. After all, many conditions are much more common among older adults. Arthritis and stroke are good examples.

But don't assume these conditions only affect the elderly. A significant number of younger people can develop them.

A new report in the medical journal Neurology makes this point well. It describes how strokes may affect younger adults. And it finds that this is happening more often. This observation comes at a time when, despite an aging population, the overall stroke rate is actually decreasing.

Researchers analyzed stroke numbers from the early 1990s, 1999 and 2005. Here's what they found:

• The average age at the time of stroke decreased from 71 to 69.
• The percentage of strokes among adults younger than age 55 increased from about 13% to nearly 19%.
• Younger adults suffering a stroke often had one or more health factors that increase people's risk of stroke.

These trends are disturbing for several reasons:

• Strokes can cause disability or even death. The impact of a stroke on a young adult may be particularly devastating. Because younger adults have more years ahead of them, they may be disabled longer than someone older who has a stroke. This means that stroke has a bigger impact on their family and work lives. It also leads to higher health care costs than someone older would have.
• There are no reliably effective treatments to reverse the brain damage caused by a stroke.
• Many strokes, including those among young adults, are preventable.

If there is any good news in this report, it is that some of the biggest contributors to the stroke rate among younger adults can be prevented. For example, the rising U.S. rates of obesity and diabetes could be reversed with enough effort and attention.

What Changes Can I Make Now?

A stroke develops when a blood vessel is blocked, interrupting blood flow to the brain. Or a blood vessel can rupture, causing bleeding into the brain. With either type of stroke, the result is brain damage. This may cause permanent loss of movement, speech, vision or memory.

Most people who have strokes have one or more health factors that increase their risk. These include:

• Smoking
• High blood pressure (hypertension)
• Diabetes
• High cholesterol
• Obesity, which increases the risk of diabetes, high blood pressure and other risk factors for stroke
• An abnormal heart beat, called atrial fibrillation
• Narrowing inside the carotid arteries, which supply blood to the brain
• Drug abuse, especially intravenous drugs or cocaine

Some of these stroke risk factors, especially obesity and diabetes, have become more widespread in recent years. Those trends likely contributed to the rising number of strokes among young adults seen in this study.

If you have any of these risk factors, talk to your doctor about how you can reduce or eliminate them. For example, a smoking cessation program could help you kick the habit. A blood thinner can lower the risk of stroke among people with atrial fibrillation. And good control of diabetes or high blood pressure can lessen stroke risk over time.

What Can I Expect Looking to the Future?

In the near future, you can expect to hear about advances in our understanding in how strokes occur and what to do about them. I think it's likely we'll have new drugs and procedures to open up blocked blood vessels in the coming years.

But I also think you'll hear much more about preventive measures. Regardless of how good our treatments get, prevention is likely to be more effective. In many cases, we already know what to do. The challenge is to get more people to do what they can to lower risk.

Assuming certain diseases are the fate of only a certain age group diverts attention from others with the same conditions. Linking these diseases with aging also can make us think they are bound to happen to those who live long enough. This new report about stroke in younger adults is a good example of how wrong these assumptions can be.