Stroke Reimagined

Prevalence of strokes among young people has increased over the recent past and emerging data has raised significant public health concerns. However, there is still a lack of research and public health initiatives on young stroke. Young adults and adolescents account for about 15% of all ischemic strokes. Among certain low-and-middle-income countries, the incidence of ischemic strokes increased by as high as 62% in those below the age of 45 years, over a 10-year follow-up period. In high-income countries such as the United States, studies have found the self-reported prevalence of strokes to be higher than that of Multiple Sclerosis and persons aged between 15-44 years.

A recent study outlined some of the risk factors, specifically among young adults that can be potentially challenging to identify and differentiate from pseudo-strokes or mimics of stroke due to varying pathologies. Risk factors such as sex and race were found to be particularly important determinant risk factors for outcome and prognosis. Some of the common cardiovascular risk factors included: hypertension, diabetes mellitus, heart disease of the valves, obesity and childhood (congenital) heart disease. Lifestyle risk factors were found to be associated with substance use (tobacco, excessive alcohol intake or narcotic usage), sedentary lifestyles with limited physical activity and poor diet. Risk factors more unique to, and common among women were listed to be – pregnancy, migraines and use of contraception such as estrogen – to name a few.

Ischemic Strokes: Are they the ‘real’ danger?

As mentioned above, ischemic strokes are not uncommon among people of the younger age groups and can affect people of all races, ethnicities, sexes and geographical locations. However, a review by Boot et al. 2020 found that the incidence of ischemic stroke was generally high in developing nations than in already developed ones. Few of the reasons for increased incidence of ischemic strokes in low-and-middle income countries, when compared with high-income countries could be due to: associated communicable diseases, lesser detection and diagnosis rates, other co-morbid conditions such as rheumatic heart disease and vascular conditions (related to blood vessels).

Apart from the factors mentioned above, another emerging issue of public health concern is climate change. Air pollution has been noted to be an emerging risk factor for stroke, globally. Increased demands for mass energy production, urbanisation, industrialisation and use of transport – all contribute to the ongoing climate crisis, as well as air pollution. Nearly 33.7% strokes in LMICs are attributed to air pollution.

However, in general, all predisposing factors for the onset of cardiovascular/ cerebrovascular disease, such as high blood pressure, cholesterol, obesity, consumption of substances (especially nicotine consumption) has significantly doubled among millennials of all genders and more so among women.

So what are some of the ways in which we can prevent young strokes and save our youth from the radar of stroke? Find out, by reading part 2 of this series!