WSC 2025 | Factors driving the rise in stroke incidence among young adults

Yeah, I’m glad you asked the question. I mean, there’s no question that the incidence and prevalence of stroke in general, whether ischemic or hemorrhagic stroke, is on the rise in the young population. And young defined as age of under 55 per some studies and age under 50 per other studies. And we have gone in sort of categorized the young population in two other categories, the youngish young or younger young, that is ages between 18 to 35, and young, which is 35 to 50 or 35 to 55. In whichever of these categories we look at, unfortunately, there is clearly a rise in incidence of stroke. Now, I wish I could say that there was just one factor that is driving all of this. But as with everything else in life, this rise is also multifactorial. Let me go through the highlights. So one of the most important reasons behind the rise in incidence is actually an increase in the traditional vascular risk factors. So traditional vascular risk factors are simply high blood pressure, diabetes, the rise in obesity, illicit drug use, and sort of increase in dyslipidemia, and also a sedentary lifestyle. So when you look at a variety of studies, whether the ones that are completed here in the United States or globally, we see a rise in these traditional vascular risk factors and importantly, a rise in what we call polymorbidity. So presence of three or more traditional vascular risk factors in these young populations, and especially in the younger young population. And so there’s lots of literature on this and sort of a call to action globally, all relevant to what we eat. So our nutrition, the sedentary lifestyle, the rise in use of electronic devices, and a decline in sort of healthy lifestyle across the world. And so unfortunately, that is an important factor behind this rise in incidence and prevalence of stroke. The next important factor, and something that we haven’t really talked a lot about, is the improved survival of childhood chronic diseases. And that’s an important thing that stroke neurologists, especially adult stroke neurologists, should be aware of. When we go back to many of the sort of unusual risks of stroke, we traditionally talk about young strokes being different than stroke in the elderly because of the lack of traditional vascular risk factors in the young and unusual causes, whether inflammatory or vasculopathy or syndromic causes of stroke being, at least in the past, the reason behind development of stroke. Now, when we look at what’s happening in the pediatric population, we see a lot of conditions in the pediatric world that used to be lethal conditions, for instance, congenital heart disease, and now with advances in pediatric care and, you know, amazing care that pediatric neurologists are providing to patients with, you know, congenital heart disease, sickle cell, you know, pediatric malignancies, these children that used to have a projected lifespan of under five years now reach adulthood. And so that is an important factor that we need to, you know, factor in when we are talking about the rising risk of stroke, understanding the impact of increased survival. And that’s something that I talked about at the World Stroke Conference and at the presentation on the rising risk of stroke. It’s an important factor. We don’t often talk about it. And briefly, very briefly, the effect of increased diagnostic capabilities. Stroke, again, is traditionally thought of as a condition that impacts the elderly with a median average age of stroke and variety of studies being about 70 years of age. So focal neurological symptoms that occurred under the age of 50 or 55 traditionally were thought to be not relevant to an ischemic stroke, migraineous phenomenon, or relevant to other conditions. So we weren’t this fast to do diagnostic studies in those patients, but with the rise of awareness and public health awareness about stroke, we’re doing more and more diagnostic imaging in our population. And so that has to have an effect or impact on our overall incidence and prevalence of stroke. Again, there is literature on this. Some researchers feel that our diagnostic capabilities have increased for both young and, you know, elderly populations. So this dichotomy is not really relevant to our increased diagnostic capabilities. And some feel like, no, we are doing it sort of more disproportionately for the young adults. But regardless, I think it’s all multifactorial, whether it’s a survival effect, whether it’s a rise in traditional risk factors or an increase in our diagnostic capabilities. And understanding that, again, because the majority of young strokes, you know, the etiology or the causes behind the young stroke is very unusual. And those unusual or those syndromic conditions, you know, we did not have the capabilities of diagnosing them. And now with the advent of advanced imaging and our advanced capabilities, we are able to make those diagnoses. There certainly has to be a relationship between our capabilities, advanced capabilities, and those diagnoses. Nonetheless, all of those are sort of hand in hand in effect, a potential reason behind this rise.

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