Explained | Why young adults suffer from stroke and how can its risk be reduced?

For a 44-year-old fitness enthusiast, Nithin Kamath, stroke came out of the blue. The co-founder and chief executive officer of stock broking platform Zerodha on Monday revealed that he suffered from a mild stroke six weeks ago and is currently recovering.

According to 2023 study conducted by medicos Syed Bukhari, Shadi Yaghi, and Zubair Bashir, originally published in the Journal of Clinical Medicine (J Clin Med) and online on PubMed Central (PMC) website, stroke is the second leading cause of deaths globally and is recognised as the "leading etiology of long-term physical and cognitive disability in adults".

Traditionally, stroke is perceived as as an old age disease but according to the study, strokes in individuals falling below the age of 50 accounts for 10 per cent of all strokes.

Kamath's unexpected stroke raised questions as to why somebody as fit as him had a stroke and what can be the cause of strokes in young adults. Moreover, how we can avoid it.

Let's take a look at the types of strokes, their triggers and prevention.

What is a stroke?

The brain need constant supply of oxygen, blood and nutrients to work well. If that supply stops for a short period of time, brain cells begin to die leading to a stroke or brain attack.

When a person suffers a stroke, brain function is lost and a person is unable to perform basic tasks like moving, speaking or eating.

According to Johns Hopkins Medicine website, there are two types of stroke - ischemic and hemorrhagic.

Ischemic stroke

It is the most common type of stroke which happens due to a block in a major blood vessel in the brain. It may be blocked by a clot or buildup of fatty deposit and cholesterol.

Hemorrhagic stroke

This stroke happens when a blood vessel in the brain bursts, spilling blood to nearby tissues, causing more damage and irritation.

What triggers a stroke?

While the causes for stroke in young adults are generally similar to that of older people, the above mentioned study noted additional factors which are unique to young adults.

The common, traditional factors include hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease.

Additional factors unique to young adults include migraine, oral contraceptive use, pregnancy and post-partum state and recreational drug use.

Traditional factors

"Prevalence of having multiple traditional stroke risk factors among young adults with ischemic stroke has doubled over the decade from 2003–2004 through 2011–2012", the J Clin Med study observed.

Atherosclerotic disease (build-up of fats, cholesterol and other substances in and on the artery walls) accounts for about one third of ischemic strokes in young adults aged 15 to 45 years.

Additionally, hypertension, hypercholesterolemia, obesity, diabetes mellitus (inadequate control of blood levels of glucose) and smoking are on the rise, contributing to increased stroke risk.

Additional factors

Migraine

Migraine has been associated with both ischemic and hemorrhagic stroke.

"Migraine was associated with a twofold increased risk of ischemic stroke, and the risk was significantly higher among people who had migraine with aura compared with people who had migraine without aura", the J Clin Med study noted.

According to the Mayo Clinic website, Migraine with aura or Classic migraine strikes after or simultaneously with sensory disturbances such as light flashes, blind spots, and other vision changes or tingling in hands or face. However, migraine without aura or common migraine does not occur with any disturbances and is common in 70 per cent of the people having migraines.

Oral contraceptives

The role of oral contraceptive pills (OCPs) is up for debate. In the earliest meta analysis of 16 studies from 1960 to 1999, it was observed that OPCs containing high dose of estrogen elevated the risk of stroke while progestin-only OCPs did not increase stroke risk.

Pregnancy and post-partum

Pregnancy and post-partum are associated with increased risk of ischemic stroke and cerebral hemorrhage.

"The risk of stroke among pregnant and postpartum women is 3 times increased when compared with nonpregnant women of similar age", the J Clin Med study noted.

Recreational drug use

The use of illicit and recreational drug is on the rise among young adults which increases the risk of both ischemic and hemorrhagic stroke.

In the Baltimore–Washington Cooperative Young Stroke Study that included 428 patients 18 to 44 years old with first stroke, the use of illicit drugs was found to be the fifth most common risk factor for ischemic stroke.

What can you do to avoid stroke?

Monitor blood pressure

High blood pressure is the biggest contributor to the risk of stroke. Monitoring blood pressure and treating it if elevated can make a big difference in stroke prevention.

"Reducing either isolated systolic or diastolic blood pressure has also been found to provide benefits in terms of reducing the risk of stroke", J Clin Med study observed.

Exercise

Exercising can reduce the risk of stroke as it helps to lose weight and control blood pressure.

Quit smoking

Smoking thickens blood which can lead to clot formation and plaque build up in arteries. Quitting smoking will reduce the risk of stroke and improve your health holistically.

Treating atrial fibrillation

Atrial fibrillation is a form of irregular heartbeat that leads to clot formation in the heart. These clots can then travel to the brain and trigger a stroke.

According to Harvard Medical School website, atrial fibrillation carries almost a fivefold risk of stroke, and should be taken seriously.

Individualise glycemic control

Diabetes mellitus is another modifiable risk factor for stroke in young adults. Recent studies have found out that young adult stroke patients with a history of diabetes are at a higher risk of in-hospital mortality and require long-term care compared to people with no diabetic history, so, individualising glycemic control can reduce the damaging risk of a stroke.

"Glycemic control should be individualized and young adults with a longer life expectancy and minimal cardiovascular disease burden may benefit from more stringent glycemic control if it can be achieved without recurrent hypoglycemia", J Clin Med study noted.

Identify a stroke FAST

The American Stroke Association has created an acronym, FAST, to spot a stroke enabling quick care for the same.

It stands for, Face Drooping, Arm weakness, Speech difficulty and Time to call. If you notice anybody facing these symptoms, you should immediately call for help so that treatment can be provided soon and mortality risk can be reduced.

The other symptoms include, numbness, confusion, trouble in vision, trouble in balancing self and severe headache.