More strokes among younger people worry experts
By American Heart Association News
When the crushing headache and other sudden problems first hit Brooke Bergfeld, she assumed they were childbirth-related. The pain came on just a week after her new son was born, after all.
Fortunately for Bergfeld, her mother knew better. She quickly called 911 after recognizing the headache, weakened left arm, slurred speech and drooping face as signs of a stroke.
Bergfeld, 29, is among the slowly growing group of younger people to suffer from the disease. The trend is surprising to some because stroke – the world’s second-leading cause of death and a leading cause of adult disability – has long been considered a health problem of the elderly.
“I would have never thought it would be something that happened to me in my 20s,” said Bergfeld, who lives in Bismark, North Dakota, and has fully recovered aside from anxiety about the possibility of another stroke. “Don’t wait until tomorrow to go in if you don’t feel right today; it could happen to anybody.”
Stroke experts have long known the disease can strike people of any age, and research in recent years has graphically illustrated it.
A 2016 study of New Jersey hospitalizations published in the Journal of the American Heart Association found that strokes more than doubled in people ages 35 to 39 between 1995 and 2014 and rose in groups up to age 55. A 2017 study in the journal JAMA Neurology also showed increases in people ages 35 to 44 from 2003 to 2012. There was a 42 percent increase in men and 30 percent increase in women, according to the analysis of stroke hospitalization records.
Mary G. George, M.D., lead author of the JAMA Neurology study and senior medical officer and deputy associate director for science with the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention, said experts don’t understand why the increase is happening. The uptick is “really concerning” because up to 80 percent of strokes are preventable, she said.
The study did offer some possible clues. From 2004-2012, there was an increase in the number of people between 18 and 64 who were at high risk in three or more of five common stroke risk factors: high blood pressure, obesity, diabetes, high cholesterol and tobacco.
Carolyn Brockington, M.D., director of the Stroke Center at Mount Sinai, St. Luke’s & Mount Sinai West Hospital in New York City, notes hormones may lead to abnormal blood clotting in some women during pregnancy, after delivery, or in those taking hormone supplements, thus raising some women’s risk of stroke.
Still, a lot is not known when it comes to young people because much previous research concentrated on older people, said Ralph L. Sacco, M.D., professor and Olemberg Chair of Neurology at the Miller School of Medicine at the University of Miami in Florida.
“More focused research on the causes of this alarming rise in the rates of stroke in younger ages is greatly needed,” said Sacco, president of the American Academy of Neurology and a past president of the American Heart Association.
Better medical therapies and improving risk factors will be necessary to reduce stroke for people of all ages, Sacco said.
James Burke, M.D., and Lesli Skolarus, M.D., suggested better brain scans using magnetic resonance imaging could partly explain the increase in young people in an editorial to the JAMA Neurology study. However, a 2015 study found the improvements were just as likely to rule out a stroke as to diagnose it.
More younger people may be getting diagnosed because some transient ischemic attacks, formerly known as “mini-strokes,” have been formally classified as actual strokes, Burke and Skolarus wrote. Transient ischemic attacks, also known as TIAs, are temporary blockages of blood flow to the brain. Before 2009, symptoms that went away within 24 hours were classified as TIAs. Since then, lasting brain damage even from fleeting symptoms is considered a stroke.
Sacco, however, does not believe that to be a factor. TIAs often go unrecognized, and not everyone who has one is hospitalized, he said. If classification was an issue, “it would likely be observed across all age groups and even more so for older patients,” Sacco said.
Birth defects such as holes in the heart or injuries that cause blood vessels to narrow also could lead to stroke among younger people, Brockington said.
Chicago resident Brady Johnson is a prime example.
The marathoner and Air National Guardsman was born with arterial venous malformation, a blood vessel defect also known as AVM, a tangled web of malfunctioning blood vessels in the brain.
Twelve years ago, when he was 31, he started having severe headaches. He attributed them to the stress of a new job and relocating to a new city, but after a brain scan doctors recommended immediate surgery. The next day had a stroke on the operating table as the AVM bled into his brain, he said.
“I did not think that it struck somebody who ran and was in shape,” said Johnson, who was told at a rehabilitation center that he would never speak clearly, read, drive or have children. “I couldn’t understand how this stroke was going to rock the rest of my life like this.”
Approaching rehabilitation like basic training, he sang to improve his speech, trained his right side to mirror his left side and re-learned to walk.
Johnson eventually got married and retired, and he’s now stay-at-home dad to his sons, ages 11 and 6. He still struggles to use the right side of his body.
Ignoring his headaches for months probably contributed to his stroke, Johnson said.
“Please find a family doctor no matter where you move to, no matter where you’re at in your life because a family doctor can help save your life,” he said.