Written by: Rachael Kopec and Abby Zuder
According to the National Institute of Health, strokes in young adults account for 10-15%
of all stroke patients.(1) This number may not seem like a lot, but with the growing prevalence of
stroke risk factors, there is an increasing incidence of stroke in young adults.(2) An ischemic
stroke happens when the brain does not receive enough blood supply, which prevents brain tissue
from getting oxygen and nutrients. Major risk factors for ischemic stroke in young adults (ages
20-50) are obesity, hypertension, and tobacco use, which all have a common link: anxiety and
stress.
In a survey conducted by the American Psychological Association, it was reported that
Generation Z has the highest reported numbers of stress in comparison to other generations, and
91% of Gen Z surveyors admitted to having one or more emotional symptoms relating to stress.
These numbers matter because in between 1993 and 2005 ischemic strokes in younger adults
increased by 50%.(3) Can you imagine what those numbers are like now? On top of that, the
American Heart Association reports that chronic anxiety increases the risk of a stroke by 33% in
young adults.(4)
There are multiple contributing factors as to why young adults are more stressed. One
example is the current state of the world. Mass shootings have ravaged the world, especially in
the United States. In 2023, there were 95+ shootings just in the United States alone, and this is only 3 months into the year. These tragedies are particularly heavy on young adults and
teenagers, so much so that the U.S Surgeon General announced a special advisory on the mental
health in youth.(5) The mental health issue came about after a 57% increase in suicides between
2007 and 2018 was cited for young adults.(4) Additional current events that Gen Z are more
emotionally distressed about than other generations are sexual assaults, immigrant deportations,
and unemployment rates due to the COVID-19 pandemic.(3) The majority of sexual assault vicitms
are under the age of 30, marking Gen Z as the primary target. Those above the age of 65 are 92%
less likely than 12-24 year olds to be a victim of sexual assault, which removes a large stressor
from older generations.(5) Unfortunately, Gen Z was also hit hard by COVID-19 and
unemployment rates. Because of the pandemic, the job market is crumbling, right as it was
recovering from the 2008 housing bubble. Those who just had just gotten jobs or were about to
get a job are struggling and under a huge amount of stress.
Besides stress, there are certain risk factors that are more unique or common based on
sex. Women are more likely than men to suffer from a stroke between the ages 15 to 30. A
unique risk factor in females are migraines with aura. Statistics have shown that women who
endure migraines with aura have a 2-fold increase in risk of an ischemic stroke and that women
with all of these risk factors are at a 9-fold increased risk of stroke.(3) Furthermore, the SITS-ISTR
registry found that smoking was twice as prevalent in young adults than older adults (ages
51-80).(6) Men are more likely to have a history of smoking, as well as coronary heart disease and
dyslipidemia.
Cardiovascular health, hypertension, and dyslipidemia are all leading factors for stroke,
with stress as an underlying cause. In 10-11% of young adults with ischemic stroke, hypertension
was a predisposing condition. Blood pressure in the 90th percentile was observed in 22% of males and 10% of females. Furthermore, almost less than 1% of young adults consume a healthy
diet according to dietary recommendations. An unhealthy diet can lead to hypertension, obesity,
and diabetes mellitus, which are all predisposing factors of stroke. Psychological stress is a
strong risk factor for dyslipidemia, which many young adults suffer from based on the stress
inducing current events mentioned previously.(6)
Due to the increasing numbers of young onset strokes and health disparities, it is
important to look into prevention. One way to protect yourself from early onset strokes is to
forgo vaping and smoking. Also, due to obesity and hypertension being one of the main
predispositions for early stroke, eating a balanced diet and exercising regularly is highly
suggested. Examining previous familial health is also important to see if your family has a
history of heart disease and stroke. Furthermore, looking into genetic history is important. In
early onset strokes, individuals who suffer from common-disease-associated single nucleotide
polymorphisms (SNPs) and monogenic diseases are at risk. Examples are Sickle-Cell disease,
Ehlers Danlos syndrome, and Cystic Fibrosis.(7) Monogenic diseases are caused by a variation in
one gene and have heavy familial inheritance patterns. Because of this, performing a genetics test
can show increased risk levels for early onset stroke.
In addition to the suggestions mentioned above, the most important form of prevention is
education. Many young adults may not be educated on early onset strokes and think of strokes as
something that can only occur once you get older. Introducing this topic to health classes in
middle school and high school would be an excellent time to educate and inform students. Also,
it would be impactful for doctors to have a talk with any young adults that fall into the age range
of early-onset strokes. Additionally, this op-ed piece can provide important insight to younger generations. Having informative pamphlets or small articles sit out at populated places can make
a huge difference.
Inspiration can be taken from Lilian Tsi Stielstra, a young onset stroke survivor. To the
shock of her neurologist, Stielstra had her stroke at the age of 46 years old. Unfortunately, this
stroke was attributed to her job that forced long hours that was met by high stress levels, high
blood pressure, and excess weight gain. Lilian said that her stroke was “the wake-up call I
needed to make a change”, and since then has exercised regularly and made a conscious effort to
have a “heart-healthy” diet. Lilian is just one person out of many that have suffered from a stroke
due to the pressures of society, but more importantly she is living proof that you can get better
due to a healthier lifestyle.(8)
Obesity, cardiovascular health, birth control use, and chronic stress are major risk factors
that are prevalent in young adult ischemic strokes. It is important to note that stress is linked to
each of these factors, and to recognize that our younger generation is more susceptible to these
stressors. The mental health and wellbeing of young adults is in jeopardy, and the increasing risk
of a stroke under the age of 50 needs to be talked about more. As Lilian Tsi Stielstra stated, “I try
to model positive changes so they [her children] can learn how not to have the same future as
me”.(8) Education, a healthy diet, and exercise can help prevent and decrease the rising number of
strokes the world is currently seeing in younger generations.
References
(1) Smajlovic, D. Strokes in Young Adults: Epidemiology and Prevention. Vascular Health
and Risk Management 2015, 157.
(2) J;, P. Ischemic stroke in young adults. https://pubmed.ncbi.nlm.nih.gov/32224758/
(accessed Apr 12, 2023).
(3) George, M. G. Risk Factors for Ischemic Stroke in Younger Adults. Stroke 2020, 51 (3),
729–735.
(4) Go Red For Women. Anxiety Linked to Increased Risk of Stroke. Blogging Stroke 2014.
(5) Bethune, S. Gen Z More Likely to Report Mental Health Concerns. Monitor On
Psychology 2019, 50 (1), 20–20.
(6) Sultan, S.; Elkind, M. S. The Growing Problem of Stroke among Young Adults. Current
Cardiology Reports 2013, 15 (12).
(7) Ekkert, A.; Šliachtenko, A.; Grigaitė, J.; Burnytė, B.; Utkus, A.; Jatužis, D. Ischemic
Stroke Genetics: What Is New and How to Apply It in Clinical Practice? Genes 2021, 13
(1), 48.
(8) CDC. Small changes that make a difference: Lilian Tsi Stielstra.
https://www.cdc.gov/stroke/survivor_stories/lilian.htm (accessed Apr 12, 2023).
Photo taken by Ashley Grasinger of the back of an ambulance (2).