The stroke risk younger adults may be overlooking—and the symptoms that should never be dismissed
Stroke is often seen as a condition that only affects older people. Yet the incidence of stroke in older people has actually fallen in recent decades. At the same time, rates of stroke in under-55s have been on the rise.
Younger adults are increasingly at risk of stroke, a condition once thought to predominantly affect older individuals. While stroke incidence among older people has decreased over recent years, stroke rates in those under 55 have been on the rise. In England, for instance, stroke incidence among 35- to 54-year-olds climbed by about 2% yearly between 2001 and 2010, despite overall rates dropping.
Similarly, in Oxfordshire, stroke rates in under-55s were about 90% higher in 2010–2018 compared to 1981–1986, while rates in older individuals fell. In the U.S., stroke rates among 20- to 54-year-olds surged from 34 to 62 cases per 100,000 people annually from 1993–1994 to 2020. Globally, nearly 2.8 million people under 55 suffered a stroke in 2021, with nearly 90% of these cases occurring in low- and middle-income countries.
A major driver of the rising stroke rates in young people appears to be modifiable risk factors that can be changed. A large international study identified ten such factors, accounting for roughly 92% of strokes in individuals under 55. High blood pressure was the most significant contributor, responsible for nearly half of all strokes in this age group.
Other major risk factors included physical inactivity, high cholesterol, poor diet, obesity, smoking, heart problems, diabetes, alcohol consumption, and psychosocial factors like stress or poor mental health.
High blood pressure alone accounted for almost half of all strokes in people under 55. Lack of regular exercise was responsible for more than a third of these cases. A U.K. study of 1,765 patients aged 18–49 hospitalized for stroke found that 42% had high blood pressure, 24% had high cholesterol, 23% smoked, and 14% had diabetes.
About 7% reported recreational drug use. Obesity and diabetes, which have been rising among younger people for three decades, often go undiagnosed or untreated in younger adults. Even untreated, these conditions can quietly elevate stroke risk. For example, under-55s with diabetes were about 3.5 times more likely to experience a stroke or ministroke compared to those without the condition, while those with high blood pressure were about 2.5 times more likely.
However, not all strokes in young people have clear causes. Around half of strokes in young people caused by a blood clot had no identifiable risk factor. Emerging research suggests that factors like air pollution, autoimmune conditions, and illicit drug use may also play a role. Stress and overworking are becoming increasingly linked to a higher risk of stroke in younger individuals.
Unfortunately, lack of awareness contributes to the problem, as my systematic review showed. People who do not perceive themselves as at risk are less likely to seek medical attention or alter their lifestyle, which may partly explain why stroke rates in younger adults have not declined as they have in older populations.
Stroke in younger adults can be overlooked more easily due to differences in symptoms compared to older individuals. While the classic signs of a stroke—face drooping on one side, arms that cannot both be lifted, and slurred or confused speech—are well-known, young people may not fit this pattern. Strokes at the back of the brain, which affect balance and vision rather than the face and arms, are more common in young adults.
Symptoms in these cases may manifest as balance issues, vision problems, headaches, neck pain, or vertigo. These symptoms may be easily dismissed by healthcare workers and young individuals who might attribute them to migraines, fatigue, hangovers, or inner ear problems. Symptoms can also resolve quickly, but immediate medical attention is crucial. Clot-busting treatment must be administered within 4.5 hours of symptom onset for optimal outcomes.
Fortunately, most strokes in younger people are linked to modifiable risk factors that individuals can change. The first step to reducing risk is to monitor blood pressure, as high blood pressure often has no symptoms and requires regular checks. Diabetics and those with a family history of heart disease or stroke should also be vigilant about monitoring cholesterol levels.
Lifestyle modifications are equally important. Avoiding smoking, refraining from recreational drugs, limiting alcohol intake to no more than 14 units per week, reducing salt consumption (no more than 6g per day), and increasing fiber intake are all recommended. Exercise is key, with at least 150 minutes of moderate activity per week—such as brisk walking or cycling—being advised.
Managing stress and avoiding long working hours are also crucial, as they have been linked to a higher risk of stroke independently of other risk factors.
Stroke is no longer a condition exclusive to older adults. Recognizing the signs and acting swiftly can save lives or prevent permanent disability. This article is republished from The Conversation under a Creative Commons license.
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