- Stroke rates in adults aged 20 to 54 have almost doubled over nearly three decades.
- The increase was mostly due to a jump in the number of ischemic strokes.
- Doctors have a few theories on what’s fueling the increase—and how you can protect yourself.
Stroke is one of the leading causes of death and disability in the U.S., making prevention strategies crucial. But while many people associate strokes with older adults, startling new research suggests that younger adults are experiencing more strokes—and the rate is increasing rapidly.
The new study, which was published in the journal Neurology, analyzed data on strokes in the Greater Cincinnati and Northern Kentucky region from 1993 through 2020. The researchers detected 2,076 first-ever strokes in adults aged 20 to 54.
After crunching the data, they discovered that the rate of strokes in younger adults increased from 33.9 cases per 100,000 person-years in 1993 to 1994 to 62.2 cases per 100,000 person-years in 2020. During the same time period, strokes actually declined in older adults, from 618.8 cases per 100,000 person-years to 453.0 per 100,000 person-years. (Person-years is a combined unit of measurement that looks at the number of people in a study and the amount of time each person participates in it.)
The increase in cases was largely driven by growing numbers of ischemic stroke, which occurs when a blood clot blocks a blood vessel in the brain. It’s by far the most common kind of stroke, making up 87% of all strokes, per the Centers for Disease Control and Prevention (CDC).
According to the study, the rate of ischemic stroke rose from 23.8 cases per 100,000 person-years in 1993-1994 to 47.3 cases per 100,000 person-years in 2020. The study didn’t find similar increases in other types of stroke.
So that means in less than three decades, cases of the most common kind of stroke nearly doubled in adults under the age of 55.
And these younger adults didn’t “just” experience a stroke: They also were more likely to develop additional health problems over time, including high blood pressure, diabetes, and atrial fibrillation, and substance use.
“We have observed clear declines in the overall number of people who experience strokes, which is a great testament to all the public health efforts that have targeted prevention of this disease and should be celebrated,” says David Robinson, M.D., senior study author and assistant professor of clinical neurology and rehabilitation medicine at University of Cincinnati. “However, even as the total number declined, the people who were having strokes were getting younger and younger.”
He points out that stroke is “devastating at any age, but it is particularly challenging in younger people, since they are still in their prime working years and may have young families to care for.”
So what’s fueling this increase in younger adults? Experts have a few theories.
Meet the experts: David Robinson, M.D., senior study author and assistant professor of clinical neurology and rehabilitation medicine at University of Cincinnati; Christian Ferreira, M.D., cerebrovascular surgeon and neuro-interventionist at Northwell’s Phelps Hospital in Sleepy Hollow, NY; Walavan Sivakumar, M.D., neurosurgeon, director of neurosurgery, and chief of staff at Providence Little Company of Mary in Torrance, CA; Elizabeth Rosen, M.D., neurologist at Tufts Medical Center; Davide Cappon, Ph.D., director of neuropsychology at Tufts Medical Center.
Why are strokes increasing in younger adults?
This new study didn’t explore why the stroke rate is rising in younger adults—it just discovered an increase. “There probably isn’t a single explanation,” says Christian Ferreira, M.D., cerebrovascular surgeon and neuro-interventionist at Northwell’s Phelps Hospital in Sleepy Hollow, NY.
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But Dr. Ferreira points out that traditional risk factors for stroke are becoming more common in younger adults. “Hypertension, diabetes, and atrial fibrillation—an irregular heartbeat—all became more prevalent over the study period,” he says.
Walavan Sivakumar, M.D., neurosurgeon, director of neurosurgery, and chief of staff at Providence Little Company of Mary in Torrance, CA, calls the findings “sobering, but not entirely surprising” based on what he’s seen with patients. The study also discovered a big increase in substance use, especially marijuana, in stroke patients, he points out.
“This doesn’t necessarily prove marijuana causes stroke on its own, but combined with stimulant use like cocaine and methamphetamine, which have a much stronger and more established link to stroke, it’s a pattern worth taking seriously,” he says.
Rising obesity rates also likely play a role, according to Dr. Robinson. “It’s well known that obesity and sedentary lifestyles have become dramatically more common over the last three decades, and this could certainly contribute to what we saw,” he says.
“The important message is that the risk factors we traditionally associate with stroke in older adults can begin accumulating decades earlier,” says Elizabeth Rosen, M.D., neurologist at Tufts Medical Center.
Ultimately, the findings raise a lot of questions. “This study cannot prove that these changes caused the increase in stroke,” Dr. Ferreira says. “However, the findings reinforce something we increasingly recognize clinically: Being relatively young does not protect someone from the consequences of hypertension, diabetes, obesity, smoking, and other vascular risk factors.”
Why are these largely ischemic strokes?
Ischemic stroke is already the most common type of stroke and that trend may simply be continuing with younger adults, Dr. Rosen says.
This study also found an increase in cardioembolic stroke—a specific type of ischemic stroke, where the clot comes from the heart—and atrial fibrillation over time, she says. “So, the pattern may reflect younger adults developing traditionally ‘older’ vascular and cardiac risk factors earlier in life.”
But it’s also possible that certain advancements in preventive care may play a role, too: Healthcare providers may be getting better at spotting other factors that contribute to other types of stroke sooner, Dr. Robinson says. “For instance, one type of hemorrhagic stroke is caused by aneurysms, where a blood vessel wall becomes weak and balloons out, making it prone to rupture,” he says. “Modern imaging can more easily find these aneurysms before they rupture and surgeons are much more likely to treat them prophylactically.” As a result, those aneurysms may be fixed before they end up causing a stroke.
How to protect yourself from stroke
Doctors stress the importance of staying on top of stroke risk factors now. “Protecting brain health starts well before old age,” says Davide Cappon, Ph.D., director of neuropsychology at Tufts Medical Center.
High blood pressure is the risk factor most closely associated with stroke, Dr. Robinson says. “Making sure your blood pressure is under control is a great start,” he says.
Being on top of your cholesterol and blood sugar, while staying physically active and addressing weight and other cardiovascular risk factors early is also crucial, according to Dr. Rosen. “Many of the most important stroke risk factors are silent—you can feel completely healthy while having hypertension, diabetes, or high cholesterol,” she says. “Stroke prevention is much easier than stroke recovery, and prevention should start long before someone thinks they are old enough to have a stroke.”
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