Study: Same Risk Factors for Stroke Found in Both Young and Older Adults

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Some of the same common risk factors that cause strokes in older adults are associated with stokes in younger adults, with young Black adults at particularly high risk, suggests a new study being presented at the American Stroke Association’s (ASA) virtual International Stroke Conference, March 17-19, 2021.

"We tend to have this clinical bias that if a person has a stroke at a young age, it is rare, or it must be from some atypical cause," said lead study author Tracy Madsen, MD, assistant professor of emergency medicine, Brown University, Providence, Rhode Island, in an ASA press release.

"But we found that the driving factors for strokes in this age group were largely the same as those for older adults," continued Madsen. "Unfortunately, there is a huge potential for loss of life and disability when people have strokes this young."

Previous research has shown that approximately 10%-15% of all strokes occur in adults aged ≤50 years. Black adults are 50% more likely to have a stroke vs white adult and 70% more likely to die from stroke vs white adults, according to the US Department of Health and Human Services Office of Minority Health.

Although the rate of stroke deaths has been decreasing overall in the past 2 decades, the decline has been greater in older adults, according to the press release. In fact, younger adults have seen stable or increased rates of stroke.

Also, while research has found high rates of traditional heart attack and stroke risk factors among young adults, there is still a question of how much those factors were contributing to strokes.

Madsen and colleagues explored that question further by examining the medical histories of 1204 Black and White adults who had strokes between the ages of 20-54 years (mean age, 46 years; women, 49%; Black, 33%) in southern Ohio and northern Kentucky.

Researchers studied common stroke risk factors (diabetes, obesity, hypertension, and high cholesterol) looking for any trends by sex and race during 5 study periods: 1993-1994, 1999, 2005, 2010, and 2015.

Results

Researchers found that hypertension was most common among Black participants, and significantly increased among Black women, increasing from 48% of the cohort in 1993-1994 to 76% in 2015.

Also, high cholesterol increased among all participants throughout the study period, although the increase was not statistically significant among White men.

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Black and White participants had high obesity rates, but it was most common among women, especially Black women. Approximately 63% of Black women had high rates of obesity vs 59% of White women, according to the preliminary results.

Approximately 40% of Black men who had strokes had been previously diagnosed with diabetes and that rate remained stable throughout the study.

With the results in mind, Madsen told the ASA that more work needs to be done to provide regular health screenings for younger patients, especially for hypertension and diabetes.

"We know that many individuals face barriers when trying to access health care, though another contributor to our findings could be that younger adults don't seek screening tests because they just aren't as worried about their health. But we can't wait until someone is 50 years old to start screening for these health problems,” said Madsen.

Once the risk factors are diagnosed, however, writing a prescription is not enough, warned Madsen.

"Our current strategy in which we just hand a prescription for blood pressure medication to our patients is not working for many individuals," concluded Madsen in the press release. "We need to go back to the drawing board and try to understand the barriers to care and how to reach all populations of people."