Strokes in Younger People Are Increasing Even As New Stroke Prevention Guidelines Are Released 

Recently, I’ve met with several married couples in their 50s where one spouse had a stroke and needed nursing home care – one had a stroke in his 40s and has been in a nursing home for many years already. This prompted me to do some research on the subject, and I found that strokes are becoming more and more prevalent among younger people. In fact, new research from the Centers for Disease Control shows that the rate of stroke has been steadily rising among Americans younger than 49 for the past 30 years. 

Strokes are the fifth-leading cause of death in the United States, and the leading cause of disability — but recently updated stroke prevention guidelines estimate that up to 80% of strokes are preventable. Strokes result in nearly 160,000 deaths annually, and every year, more than 600,000 people in the U.S. have a first stroke. That’s according to the American Stroke Association (ASA), which recently published the first guidelines for stroke prevention since 2014 in the journal Stroke.  

What Happens When a Stroke Occurs? 

The result of a stroke is that your brain does not receive the oxygen it needs to function properly. Strokes cause brain damage that can lead to significant disability, including difficulty thinking, talking, walking, and interacting with your environment. There are two different types of strokes that happen in four different ways.  

1. Ischemic Stroke. This is the most common type of stroke, accounting for about 87% of all cases. An ischemic stroke occurs when blood flow to the brain is interrupted after a blood vessel becomes blocked by a blood clot or plaque (from fatty deposits), reducing or stopping the flow of oxygen-rich blood. There are two subtypes of ischemic strokes: Thrombotic stroke: A clot forms in one of the arteries supplying blood to the brain. This often occurs due to a buildup of plaque in the arteries (atherosclerosis). 
   • Embolic stroke: A blood clot or other debris forms away from the brain (often in the heart) and is carried through the bloodstream to the brain, where it lodges in a smaller artery.
   • Hemorrhagic Stroke:  This type of stroke occurs when a blood vessel in the brain bursts, causing bleeding in or around the brain. The bleeding compresses brain tissue, leading to damage.
2. Hemorrhagic strokes account for about 13% of stroke cases, but they are more deadly than ischemic strokes. As with ischemic strokes, there are two main types of hemorrhagic strokes: 

• • Intracerebral hemorrhage: This happens when a blood vessel inside the brain bursts, spilling blood into the surrounding brain tissue.
  • Subarachnoid hemorrhage: This happens when bleeding occurs in the space between the brain and the thin tissues covering the brain. This is often caused by a ruptured aneurysm (a bulge in a blood vessel wall). 

New Stroke Guidelines Released 

The “2024 Guideline for the Primary Prevention of Stroke” replaces the 2014 version and contains a variety of prevention strategies for individuals with no prior history of stroke. The new stroke guidelines urge health care professionals to screen people for stroke risk factors, including high blood pressure, elevated cholesterol, high blood sugar, and obesity. In addition, the new guidelines highlight the American Heart Association’s Life’s Essential 8 health metrics for optimal cardiovascular and brain health, medications for risk factor management, risks specific to women, and ways to address social determinants of health. 

Highlights include: 

• The new guidelines provide evidence-based recommendations for strategies to support brain health and prevent stroke throughout a person’s lifespan by improving healthy lifestyle behaviors and getting preventive care. 

• The most common, treatable lifestyle behaviors that can help reduce stroke include: healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep and weight, controlling cholesterol, and managing blood pressure and blood sugar.  

• The guidelines recommend that adults with no prior cardiovascular disease, as well as those with increased risk, follow a Mediterranean diet, as this dietary regime has been shown to reduce the risk of stroke. 

• Healthy lifestyle behaviors, such as good nutrition, smoking cessation, and being physically active, along with routine health screenings and managing risk factors for cardiovascular disease and stroke with medication, can help prevent individuals from having a first stroke. 

• Risk factors — such as high blood pressure, obesity, elevated cholesterol. and elevated blood sugar — can be identified with physical exams and blood tests. These conditions should be addressed with healthy lifestyle and behavioral changes. 

• Key stroke prevention recommendations include regular health screenings, identifying risk factors, lifestyle interventions, and medications, when needed. 

• A new recommendation is consideration of glucagon-like protein-1 (GLP-1) receptor agonist medications, which are FDA-approved to reduce the risk of cardiovascular disease in people who are obese and/or have Type 2 diabetes. 

• Increasing public awareness and knowledge about healthy lifestyle changes — such as smoking cessation, increased physical activity, improved dietary habits, and better sleep — may also help people reduce their stroke risk. 

• Physical activity is also essential for stroke risk reduction and overall heart health.  

• Physical activity can help you improve important health measures such as blood pressure, cholesterol, inflammatory markers, insulin resistance, endothelial function, and weight.  

• Health care professionals are being urged to routinely screen patients for sedentary behavior, a confirmed risk factor for stroke, and counsel them to engage in regular physical activity.  

• The recommendation is that adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. Be sure to check with your doctor before starting any exercise program. 

• New to the guidelines is an emphasis on social determinants of health and the impact they have on stroke risk. These can include non-medical factors, such as education, economic stability, access to care, and neighborhood factors (such as the lack of walkability, lower availability of healthy food, and fewer health resources), that contribute to inequities in care and influence overall health.  

• The guideline also includes some new gender- and sex-specific recommendations for women that can increase a woman’s risk of stroke, including use of oral contraceptives, high blood pressure during pregnancy, other pregnancy complications such as premature birth, early onset menopause, and more. Treatment of elevated blood pressure during pregnancy and within six weeks of delivery is highly recommended. 

• Transgender women and gender-diverse individuals taking estrogens for gender affirmation may also be at an increased risk of stroke.  

According to Cheryl Bushnell, lead author, these guidelines are important because “new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke.”  

Recognizing the Symptoms of a Stroke 

If a stroke is identified early and you get prompt medical intervention, you are more likely to have a good outcome. That’s why it is important for you to recognize the signs of stroke and know when to get help. If recognized early, there are multiple treatments that can be used in the first few hours to 24 hours to prevent the most serious effects and complications. 

The following is the “BE FAST” method for stroke identification: 

• Balance: Are you experiencing sudden loss of balance or dizziness? 

• Eyes: Do you have any loss of vision? 

• Face: Does your face or your smile look uneven, or is one side of your face drooping? 

• Arm: Is one arm or leg hanging down, or do you feel weak on one side? 

• Speech: Are you having trouble speaking, communicating, or understanding others? Is your speech slurred? 

• Time to call 911. 

Learning about Risk Factors for Stroke  

Many people are under the misconception that stroke is something only older adults have to worry about. But these risks are present even when you look like you’re in your healthiest years. Implementing healthy life changes earlier in life can pay dividends not only in terms of stroke prevention but also in improving overall health.  

If you have any risk factors for stroke, talk to your doctor about ways to reduce your risk. You may need to take medication or make lifestyle changes, such as exercise and eating a healthy diet. 

Remember, a stroke is a medical emergency; the sooner you’re treated, the better your chances of recovery. 

Plan Ahead for Peace of Mind  

Healthy habits are sometimes not enough to prevent a medical emergency such as a stroke. That’s why adults of all ages should sign an advance medical directive and a general power of attorney. Signing these incapacity planning documents is the only way to ensure that your wishes are met in the simplest and least expensive manner if you should become unable to make important decisions for yourself.  

If you have not done incapacity planning or estate planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact the Farr Law Firm as soon as possible to make an appointment:  

Northern Virginia Elder Law: 703-691-1888
Fredericksburg Estate Planning: 540-479-1435
Maryland Medicaid Planning: 301-519-8041
DC Elder Care: 202-587-2797