Stroke a Growing Problem in the Young

The average age of patients presenting with a first stroke in the greater Cincinnati area dropped nearly 3 years, from about age 71 in 1993 to age 68 in 2005, researchers found.

And the percentage of patients with stroke who were younger than 45 increased from 4.5 percent to over 7 percent during the same time period, Dr. Brett Kissela of the University of Cincinnati Neuroscience Institute reported at the American Stroke Association meeting in San Antonio, Texas.

"That's tragic because young people, if they're disabled from stroke, that's a lot of productive life lost," he said.

"I think for many of them they face a lifelong prospect of disability, reduced income levels, and challenges at home," said Dr. Brian Silver, a neurologist at Henry Ford Hospital in Detroit.

Kissela and Silver, who was not involved in the study, both speculated that the increasing prevalence of risks factors typically found in older individuals, such as diabetes, hypertension, and obesity, in younger people may be driving the trend.

Kissela's group previously found that diabetes in particular imparted a five- to 10-fold increased risk of stroke in those younger than 65.

"We're just seeing these conditions come sooner, so it's probably not surprising that the strokes would come sooner," Kissela said.

Although the trend is concerning, he said, the absolute risk of stroke remains substantially lower in younger patients than in their older counterparts, occurring in 25 per 100,000 whites and 55 per 100,000 blacks 20 to 44 years old in 2005. The rates for those 85 and older were 1,263 per 100,000 whites and 1,029 per 100,000 blacks.

Kissela and his colleagues decided to look at the average age of patients when they noticed an increase in younger patients presenting with stroke.

Data came from 17 hospitals in the Cincinnati metropolitan area, including two counties in Ohio and three in northern Kentucky.

The population of about 1.3 million people was representative of the entire United States for age, proportion of blacks, median income, and education level, according to Kissela. Hispanics, however, were underrepresented.

Although the rate of stroke increased in the younger patients, rates dropped in blacks 85 and older and in whites 65 and older.

But, said Silver, "even though in the older patients in this study the rates were going down, we're seeing a rise in stroke rate among younger patients, which means some of the gains we're making are being offset by the fact that these younger patients are having stroke."

"So we're taking maybe one step forward and then taking two steps backward."

He said the results of Kissela's study likely represent what is going on in the rest of the U.S., noting that in his practice, he has seen about five patients in their 30s and 40s with stroke in the past two weeks, a stark contrast to just a decade ago.

"I do believe that this is probably something that is true around the country," Silver said.

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