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Why strokes among younger adults have soared

Robin Wulffson MD's picture
stroke, younger adults, smoking, substance abuse, cocaine, methamphetamine

Strokes are generally considered to be a condition that occurs among the elderly; however, the rate of strokes has increased significantly in the United States among younger adults. Researchers affiliated with the University of Cincinnati conducted a study to determine the reasons behind this increase. They published their findings online on November 15 in the journal Stroke.

According to the Centers for Disease Control and Prevention (CDC), nearly 800,000 individuals in the United States suffer a stroke every year, and the condition is the most common cause of serious long-term disability. A study conducted in 2007 reported that that almost 5% of people who had suffered a stroke that year were between ages 18 and 44. The investigators noted that substance abuse is a prevalent risk factor for stroke in young adults; therefore, they conducted a study to identify trends in substance abuse detection among stroke patients.

The researchers attempted to identify all patients aged 18 to 54 years experiencing a stroke (ischemic or hemorrhagic) in the Greater Cincinnati and Northern Kentucky Study region during 1993 to 1994, 1999, and 2005. (An ischemic stroke is caused by a blocked vessel while a hemorrhagic stroke is caused by leakage of blood from a blood vessel into the brain.) Demographic and clinical characteristics and substance use data were obtained retrospectively from chart review and adjudicated by physicians. The researchers reviewed medical charts for blood or urine test results of other records of substance abuse for nearly 1,200 stroke patients.

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The researchers found that the number of young patients identified with a stroke increased from 1993 to 1994 (297 cases) to 2005 (501 cases). Blacks (61% vs. 51%) and men (61% vs. 47%) reported substance abuse (i.e., current smoking, alcohol abuse, or illegal drug use) more frequently than did whites and women. Overall, the use of substances increased across study periods: 45% in 1993 vs. 62% in 2005). The trend was significant for illegal drug use (3.8% in 1993 vs. 19.8% in 2005) and ever smoking (49% in 1993 vs. 66% in 2005). Documentation of both cocaine and marijuana use increased over time. In 2005, half of young adults with a stroke were current smokers, and 1 in 5 abused illegal drugs.

The authors concluded that substance abuse is common in young adults experiencing a stroke. The observed increase in substance abuse is contributing to the increased incidence of stroke in young adults. They recommended that patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse.

Take home message:
The results of this study are not surprising, given the deleterious effects of smoking and substance abuse. Smoking is a definite risk factor for cardiovascular disease (heart attacks and strokes). Among illegal substances, cocaine, methamphetamine, and other central nervous stimulants pose the greatest risk of a stroke. These substances significantly increase blood pressure. The increased blood pressure can cause a rupture of a blood vessel in the brain, which produces a hemorrhagic stroke.

Reference: Stroke

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