Risk of stroke in young and middle-aged adults
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It was a hot July day in Nashville. Sekou Writes, a 51-year-old writer from New York, had just delivered a speech at a graduation ceremony for a summer youth program he had directed. He descended from the dais as everything froze.
“I dropped those [paper] program that I had held,” says Writes. “I wanted to reach for it, but I couldn’t reach it. I just got stuck there.”
The next thing he remembers were hands on his back, but he couldn’t turn to see who was holding him up.
“From that moment on, I was just seeing snippets of things, then I woke up in a place with a crib and I didn’t know who these people were around me,” says Writes. “My language centers didn’t seem to be working. My arm didn’t seem to be working. It was unnerving.” He later found out he had a hemorrhagic stroke. (There are two types of stroke. Hemorrhagic strokes involve bleeding in the brain. Ischemic strokes, which are more common, are caused by blood clots.)
When you hear about someone who’s had a stroke, you probably imagine someone much older — maybe in their 70s or older — and who has other medical issues that seem common with aging. Someone like Writes, who exercises regularly and hasn’t had any medical warning signs, is probably not who you imagine having a stroke.
But new research shows that stroke rates are increasing among young adults and those like Writes who are middle-aged. A specific type of bleeding stroke known as intracerebral hemorrhage (ICH) has increased by 11% over the past decade, according to the American Heart Association.
Why is this happening? And what can be done to stop this trend?
No red flags
When Writes had his stroke, on day 409 of his solo challenge, he was about to run at least 1 mile every day, regardless of the weather, location, or mood.
He started his running streak in June 2021 for his birthday. The plan was to see if he could run at least 1 mile every day for a month. Over the next month, he expanded his one-man race and added donations to the mission, donating the money to various causes and groups to help the homeless.
“It kept growing every month, a new mission, a new person that I gave the money to,” says Writes. “I ran in 25 different cities and raised more than $7,000.”
But the charity run streak ended abruptly, at least temporarily, when he had his stroke.
Lifestyle as a risk factor
“While race, gender and genetics contribute to some of these cases [of ICH strokes]the far more common risk factors are lifestyle,” says Dr. Chirag Gandhi, director of the Brain and Spine Institute at Westchester Medical Center in New York.
When it comes to ischemic and ICH strokes, high blood pressure, diabetes, smoking, obesity and a sedentary lifestyle all increase your risk, whether you’re middle-aged or older, he says. Your risk is higher if you don’t have access to good medical care.
The focus should be on the rise in high blood pressure, or high blood pressure, in young adults, says John H. Hanna, MD, vascular neurologist and medical director of Atlantic Health System’s Comprehensive Stroke Center at Overlook Medical Center in Summit, NJ.
Data links high blood pressure and the incidence of stroke in young people, says Christina Johns, MD, pediatric emergency physician and senior medical adviser at PM Pediatric Care in Annapolis, MD. “This is exacerbated by obesity, poor diet and smoking,” she says. While it hasn’t been definitively proven, a more sedentary lifestyle, “particularly involving more screen time during work-from-home/stay-at-home measures during the pandemic, could be contributing to this increase,” she says.
What about COVID-19?
Stroke rates in younger people started to rise before COVID-19. But “in some cases, strokes have been reported as a result of severe COVID infection,” says Hanna. Because the COVID-19 virus is still relatively new, there is not yet any long-term data to support the association.
However, scientists do know that COVID-19 “causes a diffuse inflammatory cascade in the body that affects multiple organ systems,” says Gandhi. And sometimes this cascade leads to blood clots, which can lead to a stroke, he says.
Prevention through education
The good news is that the lifestyle risk factors that put someone at risk of stroke are not set in stone. Prevention is possible through education. Small but meaningful changes in your everyday life can reduce your risk of stroke.
You can change your lifestyle by combining healthier diet choices – e.g. B. limiting high-fat foods and not drinking too much alcohol – and engaging in more physical activity, such. B. Dedicated daily walks, says Gandhi. “Also, close communication with a physician for screenings, routine physical exams, and possibly initiation of medications when needed” are helpful, simple adjustments. Your doctor can assess your risk of stroke and make specific recommendations about what can help you reduce that risk.
Writes works with physical therapists to improve his mobility, speech and memory. He stayed on track while running and now pays extra attention to staying hydrated. Although hydration isn’t a formal part of his stroke recovery, it supports his body during a demanding endurance activity. He ran the full 26.2 miles in the New York City Marathon and crossed the finish line with ebullient pride.
“I’ve changed. And that change is still manifesting,” Writes says of his life after his stroke. “I try to go with the flow and focus on making myself 1% better every day.”
