Stroke in young adults: Current trends, opportunities for prevention and pathways forward

Abstract

Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20-44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and loss of productivity, all of which have vast personal, social and economic implications. These concerning trends among young adults are likely due to increasing trends in the prevalence of modifiable risk factors amongst this population including hypertension, hyperlipidemia, obesity and diabetes, highlighting the importance of early detection and aggressive prevention strategies in the general population at early ages. In parallel and compounding to the issue, troublesome trends are evident regarding increasing rates of substance abuse among young adults. Higher rates of strokes have been noted particularly among young African Americans, indicating the need for tailored prevention and social efforts targeting this and other vulnerable groups, including the primordial prevention of risk factors in the first place, reducing stroke rates in the presence of prevalent risk factors such as hypertension, and improving outcomes through enhanced healthcare access. In this narrative review we aim to emphasize the importance of stroke in young adults as a growing public health issue and increase awareness among clinicians and the public health sector. For this purpose, we summarize the available data on stroke in young adults and discuss the underlying epidemiology, etiology, risk factors, prognosis and opportunities for timely prevention of stroke specifically at young ages. Furthermore, this review highlights the gaps in knowledge and proposes future directions moving forward.

Keywords: Review; Stroke; Young adults.

Fig. 1

Incidence of stroke in young adults per 100,000 in the US and Europe. ∗All stroke in patients aged 20–44 ​Years old. ∗∗ Ischemic stroke in patients aged <55 ​Years old. Adapted from Ref. [10] Madsen TE, Khoury JC, Leppert M, Alwell K, Moomaw CJ, Sucharew H, Woo D, Ferioli S, Martini S, Adeoye O, Khatri P. Temporal Trends in Stroke Incidence Over Time by Sex and Age in the GCNKSS. Stroke. 2020 Apr; 51 (4):1070–6. [11]; Béjot Y, Daubail B, Jacquin A, Durier J, Osseby GV, Rouaud O, Giroud M. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. Journal of Neurology, Neurosurgery & Psychiatry. 2014 May 1; 85 (5):509–13.

Fig. 2

30-day fatality and cumulative mortality in 30-day survivors of stroke in young adults∗ ∗ Data for ​≥ ​1-year mortality presented as cumulative incidence of mortality among survivors of first 30 days post-stroke. Adapted from Ref. [54] Rutten-Jacobs LC, Arntz RM, Maaijwee NA, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, de Leeuw FE. Long-term mortality after stroke among adults aged 18–50 years. Jama. 2013 Mar 20; 309 (11):1136–44.