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ExplainedWhy Young Adults Suffer From Stroke And How Can Its Risk Be Reduced?
For a 44-year-old fitness enthusiast, Nithin Kamath, stroke came out of the blue. The co-founder and chief executive officer of stock broking platform Zerodha on Monday revealed that he suffered from a mild stroke six weeks ago and is currently recovering.
According to 2023 study conducted by medicos Syed Bukhari, Shadi Yaghi, and Zubair Bashir, originally published in the Journal of Clinical Medicine (J Clin Med) and online on PubMed Central (PMC) website, stroke is the second leading cause of deaths globally and is recognised as the "leading etiology of long-term physical and cognitive disability in adults".
Traditionally, stroke is perceived as as an old age disease but according to the study, strokes in individuals falling below the age of 50 accounts for 10 per cent of all strokes.
Kamath's unexpected stroke raised questions as to why somebody as fit as him had a stroke and what can be the cause of strokes in young adults. Moreover, how we can avoid it.
Let's take a look at the types of strokes, their triggers and prevention.
What is a stroke?
The brain need constant supply of oxygen, blood and nutrients to work well. If that supply stops for a short period of time, brain cells begin to die leading to a stroke or brain attack.
When a person suffers a stroke, brain function is lost and a person is unable to perform basic tasks like moving, speaking or eating.
According to Johns Hopkins Medicine website, there are two types of stroke - ischemic and hemorrhagic.
Ischemic stroke
It is the most common type of stroke which happens due to a block in a major blood vessel in the brain. It may be blocked by a clot or buildup of fatty deposit and cholesterol.
Hemorrhagic stroke
This stroke happens when a blood vessel in the brain bursts, spilling blood to nearby tissues, causing more damage and irritation.
What triggers a stroke?
While the causes for stroke in young adults are generally similar to that of older people, the above mentioned study noted additional factors which are unique to young adults.
The common, traditional factors include hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease.
Additional factors unique to young adults include migraine, oral contraceptive use, pregnancy and post-partum state and recreational drug use.
Traditional factors
"Prevalence of having multiple traditional stroke risk factors among young adults with ischemic stroke has doubled over the decade from 2003–2004 through 2011–2012", the J Clin Med study observed.
Atherosclerotic disease (build-up of fats, cholesterol and other substances in and on the artery walls) accounts for about one third of ischemic strokes in young adults aged 15 to 45 years.
Additionally, hypertension, hypercholesterolemia, obesity, diabetes mellitus (inadequate control of blood levels of glucose) and smoking are on the rise, contributing to increased stroke risk.
Additional factors
Migraine
Migraine has been associated with both ischemic and hemorrhagic stroke.
"Migraine was associated with a twofold increased risk of ischemic stroke, and the risk was significantly higher among people who had migraine with aura compared with people who had migraine without aura", the J Clin Med study noted.
According to the Mayo Clinic website, Migraine with aura or Classic migraine strikes after or simultaneously with sensory disturbances such as light flashes, blind spots, and other vision changes or tingling in hands or face. However, migraine without aura or common migraine does not occur with any disturbances and is common in 70 per cent of the people having migraines.
Oral contraceptives
The role of oral contraceptive pills (OCPs) is up for debate. In the earliest meta analysis of 16 studies from 1960 to 1999, it was observed that OPCs containing high dose of estrogen elevated the risk of stroke while progestin-only OCPs did not increase stroke risk.
Pregnancy and post-partum
Pregnancy and post-partum are associated with increased risk of ischemic stroke and cerebral hemorrhage.
"The risk of stroke among pregnant and postpartum women is 3 times increased when compared with nonpregnant women of similar age", the J Clin Med study noted.
Recreational drug use
The use of illicit and recreational drug is on the rise among young adults which increases the risk of both ischemic and hemorrhagic stroke.
In the Baltimore–Washington Cooperative Young Stroke Study that included 428 patients 18 to 44 years old with first stroke, the use of illicit drugs was found to be the fifth most common risk factor for ischemic stroke.
What can you do to avoid stroke?
Monitor blood pressure
High blood pressure is the biggest contributor to the risk of stroke. Monitoring blood pressure and treating it if elevated can make a big difference in stroke prevention.
"Reducing either isolated systolic or diastolic blood pressure has also been found to provide benefits in terms of reducing the risk of stroke", J Clin Med study observed.
Exercise
Exercising can reduce the risk of stroke as it helps to lose weight and control blood pressure.
Quit smoking
Smoking thickens blood which can lead to clot formation and plaque build up in arteries. Quitting smoking will reduce the risk of stroke and improve your health holistically.
Treating atrial fibrillation
Atrial fibrillation is a form of irregular heartbeat that leads to clot formation in the heart. These clots can then travel to the brain and trigger a stroke.
According to Harvard Medical School website, atrial fibrillation carries almost a fivefold risk of stroke, and should be taken seriously.
Individualise glycemic control
Diabetes mellitus is another modifiable risk factor for stroke in young adults. Recent studies have found out that young adult stroke patients with a history of diabetes are at a higher risk of in-hospital mortality and require long-term care compared to people with no diabetic history, so, individualising glycemic control can reduce the damaging risk of a stroke.
"Glycemic control should be individualized and young adults with a longer life expectancy and minimal cardiovascular disease burden may benefit from more stringent glycemic control if it can be achieved without recurrent hypoglycemia", J Clin Med study noted.
Identify a stroke FAST
The American Stroke Association has created an acronym, FAST, to spot a stroke enabling quick care for the same.
It stands for, Face Drooping, Arm weakness, Speech difficulty and Time to call. If you notice anybody facing these symptoms, you should immediately call for help so that treatment can be provided soon and mortality risk can be reduced.
The other symptoms include, numbness, confusion, trouble in vision, trouble in balancing self and severe headache.
Young People More Likely To Be Out Of Work That Those In Early 40s
Individuals in their early twenties are more likely to be out of work due to ill health compared to those in their early forties, according to a report.
According to the Resolution Foundation, this marks a "radical departure" from previous trends that indicated the likelihood of not working due to sickness increased with age.
Official statistics indicate a rising trend of poor mental health among the youth.
Growing number of young people out of workIt was found that one in twenty young people (5%) were not engaged in work or education due to ill health in 2023.
Such conditions could negatively affect their education, leading to lower-paid employment or unemployment, the report highlighted.
The report identifies young people as having the worst mental health across all age groups.
This is a significant shift from two decades prior when they exhibited the lowest rates of common mental disorders.
In the period of 2021/22, 34% of individuals aged 18 to 24 reported experiencing symptoms of mental disorders, such as depression, anxiety, or bipolar disorder, a rise from 24% in 2000.
Consequently, over half a million individuals aged 18 to 24 were prescribed antidepressants in 2021-22.
The study reveals a troubling increase in worklessness due to ill health among the young, raising concerns about the impact of illness on young people's ability to work.
1 in 3 young non-graduates have a mental disorderLouise Murphy, a senior economist at the Resolution Foundation said: "The economic impacts of poor mental health are most severe for young people who do not attend university, with one in three young non-graduates with a common mental disorder currently without work".
The research indicates that young women are particularly affected, being one-and-a-half times more likely to suffer from poor mental health compared to young men (41% versus 26%).
The study also found that 79% of 18 to 24-year-olds who are not in employment due to ill health possess only qualifications at or below GCSE level.
This is in contrast to 34% of all people in that age group.
Children aged 11 to 14 who experience poor mental health are three times more likely not to achieve five GCSEs, including English and Maths, compared to their healthier peers, according to the report.
Employment and education fundamental to healthJo Bibby, director of the Health Foundation, said that "good employment and education" are fundamental to health.
The findings of the study primarily derive from the Labour Force Survey, which has been discontinued by the Office for National Statistics due to a decline in participation.
However, the Health Foundation maintains that the data remains sufficiently accurate for their analysis.
What Is High Blood Pressure? Symptoms, Causes, Diagnosis, Treatment, And Prevention
The following can increase your chances of developing high blood pressure.
Age The risk of high blood pressure increases as you age; the older you are, the more likely you are to develop high blood pressure. Blood vessels gradually lose their elasticity over time, which can contribute to high blood pressure.[2]
The risk of prehypertension and high blood pressure has been increasing in recent years in young people too, including children and teens, possibly because of the rise in obesity in these populations.[3]
Race High blood pressure is more common in Black American adults than in white, Asian, or Hispanic American adults.[4]
Gender Men are more likely than women to be diagnosed with high blood pressure, until age 64.[2] However, after that age, women are more likely to have high blood pressure.
Family History Having a family history of high blood pressure increases your risk, as the condition tends to run in families.[2]
Weight The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. When the volume of blood pumping through your blood vessels increases, the pressure on your artery walls also rises.[5]
Physical Activity People who are not active tend to have a higher heart rate and higher blood pressure than those who are physically active.[5] Not exercising also increases the risk of being overweight.
Tobacco Use When you smoke or chew tobacco, your blood pressure rises temporarily, partly from the effects of nicotine. Moreover, chemicals in tobacco can damage the lining of your artery walls, which can cause your arteries to narrow, increasing your blood pressure.[5] Being exposed to secondhand smoke may also increase your blood pressure.
Diet What you choose to eat (and not to eat) can increase your risk of hypertension:[5]
[6]
Stress Being under intense stress can lead to a temporary increase in blood pressure.[2] Moreover, if you try to cope with stress by overeating, using tobacco, or drinking alcohol, all of these can contribute to high blood pressure.
Chronic Conditions Having kidney disease, sleep apnea, or diabetes can affect blood pressure.[5]
Pregnancy Being pregnant can cause an increase in blood pressure. High blood pressure occurs in 1 in every 12 to 17 pregnancies in women ages 20 to 44.[7]
Birth Control Women who take birth control pills have a greater risk of developing high blood pressure. It's more likely to occur when women are overweight, have had high blood pressure during a previous pregnancy, have a family history of blood pressure, smoke, or have mild kidney disease.[8]
Causes of Secondary HypertensionWhen high blood pressure arises suddenly due to an identifiable condition, it's called secondary hypertension.
The following conditions can lead to secondary hypertension, including:[5]
Medications that you take to control other health conditions, such as arthritis, epilepsy, or allergies, can cause your blood pressure to rise.
They can also interfere with the ability of drugs used to keep blood pressure down.
The drugs below are some of the ones that may negatively affect blood pressure.[9]
Pain Medications Common pain and anti-inflammatory medicines can lead to water retention, which can increase blood pressure and create problems with the kidneys.
Examples include:
Antidepressants These drugs work by changing the body's response to chemicals that affect mood. That can also lead to an increase in blood pressure.
Examples of antidepressants that may elevate blood pressure include:
Decongestants These medicines, which include common cough, cold, and allergy drugs, are known to raise blood pressure and to alter the effectiveness of blood pressure medication.
Examples include pseudoephedrine (Sudafed, Contac) and phenylephrine (Sudafed PE).
Hormones Birth control pills can also affect blood pressure. Women who take birth control pills usually experience a small rise in systolic and diastolic blood pressure (the top and bottom numbers that are determined when you get your blood pressure checked).
Hormone therapy used to relieve symptoms of menopause can also cause a small rise in systolic blood pressure.
If you know you have high blood pressure but are considering hormone therapy, talk with your doctor about the risks and benefits of undergoing hormone therapy, as well as the best ways to control your blood pressure.
Additionally, some recreational and illegal drugs, such as cocaine, ecstasy (MDMA), and amphetamines, are also known to increase blood pressure.
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