Stroke Risk in Young and Middle-Aged Adults
It was a hot July day in Nashville. Sekou Writes, a 51-year-old writer based in New York, had just given a speech at a graduation ceremony for a youth summer program he had been leading. He stepped down from the podium when everything froze.
“I dropped the [paper] program that I had been holding,” Writes says. “I was reaching for it, but I couldn’t get to it. I was just stuck there.”
The next thing he remembers was hands on his back, but he couldn’t turn to see who was holding him up.
“From that moment on, it’s just snippets of things that I saw, then waking up in a place with a cot and not knowing who these people were around me,” Writes says. “My speech centers didn’t seem to work. My arm didn’t seem to work. It was unnerving.” He found out later that he’d had a hemorrhagic stroke. (There are two types of strokes. Hemorrhagic strokes involve bleeding in the brain. Ischemic strokes, which are more common, are caused by blood clots.)
When you hear about someone having a stroke, you probably picture someone much older – maybe in their 70s or beyond – who has other medical issues that seem common with aging. Someone like Writes, who exercises regularly and had no medical red flags, likely isn’t who you imagine having a stroke.
But new research shows that strokes are rising among young adults and those, like Writes, who are in middle age. One particular type of bleeding stroke, called an intracerebral hemorrhage (ICH), is up 11% in the past decade, according to the American Heart Association.
Why is this happening? And what can be done to stop this trend in its tracks?
No Red Flags
When Writes had his stroke, he was on day 409 of his solo challenge to run at least 1 mile every day, no matter the weather, location, or mood.
He had started his running streak in June of 2021 for his birthday. The plan was to see if he could run 1 mile, minimum, every day for a month. The next month, he extended his one-man race and added fundraising to the mission, donating the money to different causes and groups supporting the unhoused.
“It just kept growing every month, a new mission, new person I was giving the money to,” Writes says. “I ran in 25 different cities and raised more than $7,000.”
But the charity running streak abruptly ended, at least temporarily, when he had his stroke.
Lifestyle as a Risk Factor
“While race, gender, and genetic predisposition are contributors to some of these cases [of ICH strokes], the far more common risk factors are lifestyle,” says Chirag Gandhi, MD, the director of the Brain and Spine Institute at Westchester Medical Center in New York.
When it comes to both ischemic and ICH strokes, high blood pressure, diabetes, smoking, obesity, and lack of physical activity raise 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 rise in hypertension, or high blood pressure, in young adults should be the main focus, says John H. Hanna, MD, a vascular neurologist and the medical director of Atlantic Health System’s Comprehensive Stroke Center at Overlook Medical Center in Summit, NJ.
Data links high blood pressure and incidence of stroke in young people, says Christina Johns, MD, a pediatric emergency doctor and senior medical adviser at PM Pediatric Care in Annapolis, MD. “This is exacerbated by obesity, poor diet, and smoking,” she says. Although it hasn’t been definitively proved, a more sedentary lifestyle, “especially with increased time in front of a screen during work from home/stay at home measures during the pandemic, may be contributing to this increase,” she says.
What About COVID-19?
Strokes among younger people started rising before COVID-19. But “in some cases, strokes have been reported as a consequence of having severe COVID infection,” Hanna says. Since the COVID-19 virus is still relatively new, there isn’t any long-term data yet to support the connection.
Still, scientists know that COVID-19 causes “a diffuse inflammatory cascade within the body, impacting multiple organ systems,” Gandhi says. And at times, this cascade prompts clots that can lead to stroke, he says.
Prevention Through Education
The good news is, the lifestyle risk factors that put someone at risk of stroke are not set in stone. Prevention is possible through education. Making small but meaningful changes to your day-to-day can reduce your risk of stroke.
You can modify your lifestyle by combining healthier choices for your diet – such as limiting high-fat foods and not drinking too much alcohol – and getting more physical activity, like dedicated daily walks, Gandhi says. “Plus, being in close communication with a physician for screenings, routine physicals, and potentially initiating medications when needed” are all helpful, simple adjustments. Your doctor can assess your stroke risk and make specific recommendations about what will help you lower that risk.
As for Writes, he’s working with physical therapists to improve his mobility, speech, and memory. He stayed on track with his 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 walked the full 26.2 miles in the New York City Marathon, crossing the finish line with pride overflowing.
“I’ve changed. And that change is still making itself manifest,” Writes says about his life after his stroke. “I’m trying to go with the flow and focus on making myself 1% better every day.”