Stroke Occurring at Younger Ages

Megan Brooks

October 11, 2012

October 11, 2012 — Stroke is no longer a disease of the old. A new study shows that stroke is becoming more common in younger people.

This finding, say researchers, has "great public health significance because strokes in younger patients carry the potential for greater lifetime burden of disability and because some potential contributors identified for this trend are modifiable."

"With the epidemic of diabetes and obesity, clearly risk factors are happening at younger ages," Brett M. Kissela, MD, from University of Cincinnati College of Medicine in Ohio told Medscape Medical News.

Dr. Brett Kissela

"And if you think of stroke as a potential downstream consequence of risk factors — even when treated, but certainly more likely when untreated — then it's not surprising that if risk factors come early that we are seeing stroke come earlier as well," he added.

The study was published online October 10 in Neurology.

Data Support a Clinical Observation

Dr. Kissela and colleagues used the population-based Greater Cincinnati/Northern Kentucky Stroke Study to examine temporal trends in stroke incidence stratified by age. They found that the average age at stroke decreased significantly from 71.2 years in 1993-1994 to 69.2 years in 2005 (P < .0001).

Moreover, the proportion of all strokes in the under-55 age group increased from 12.9% in 1993-1994 to 18.6% in 2005. Regression modeling showed a significant change over time (P = .002), characterized by a shift to younger strokes in 2005 compared with earlier study periods, the researchers say.

In the 20-to-54 age range, incident stroke per 100,000 increased from 26 in 1993-1994 to 48 in 2005 among whites and from 83 in 1993-1994 to 128 in 2005 among blacks.

"When I first started caring for stroke patients it seemed I was caring for older folks beyond retirement age," Dr. Kissela told Medscape Medical News. "Over time, I have definitely seen that shift to where it is very common to see a large proportion of middle age or younger people in the hospital with stroke. We did this study to see whether that indeed has been the trend over time and that is what the data show."

As reported by Medscape Medical News, a recent study from the Centers for Disease Control and Prevention also found a trend for increasing stroke incidence at younger ages in a national database.

Although it's not clear from the current study what the ultimate cause for this trend is, several factors are certainly at play, Dr. Kissela said.

"I truly believe that it has to do with the risk factors for stroke that are occurring so much more commonly in young people, like hypertension, diabetes, which cluster together with obesity and high cholesterol in the metabolic syndrome," he said.

However, it's also possible that more strokes in the young are being detected because of greater use of magnetic resonance imaging, the researchers say.

Daunting Future Trajectory

The authors of an editorial published with the study say the increase in stroke incidence among the younger set "suggests an unknown and potentially daunting future trajectory."

"Replication of these findings in other US populations and internationally is crucial, and future studies will need to account for potential temporal trends in diagnostic testing while also teasing out causative factors," write Sally Sultan, MD, and Mitchell S. Elkind, MD, from Columbia University in New York City.

"Fortunately, the American Academy of Neurology has established a Task Force for Stroke in Young Adults and Adolescents to address these issues….Should the trend prove valid and widespread, timely support for other new initiatives to improve health during our prime years will be required," they conclude.

Complicating matters, said Dr. Kissela, is the fact that young people are less likely to go to the doctor, "especially in this economic environment, and so the public health message to go see your doctor is an important one."

The study was supported by the National Institutes of Health. The authors and Dr. Sultan have disclosed no relevant financial relationships. Dr. Elkind serves as a consultant to Jarvik Heart; receives research support from diaDexus Inc and Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; and has given expert testimony on behalf of Novartis, GlaxoSmithKline, and Organon. He serves as Resident & Fellow Section Editor for Neurology, for which he receives compensation from the American Academy of Neurology.

Neurology. 2012;79:1781-1787. Abstract Editorial