Many people think of stroke as a disease that affects older adults. They are often surprised to learn that stroke is the eighth leading cause of death among people ages 25 to 45, according to data collected by the Centers for Disease Control and Prevention. Researchers from the University of Maryland recently studied stroke risk factors, prevalence, and disparities among younger people. The study examined the data through the lens of race (Black and white), gender, and age (15 to 49 years).

Previous studies have established that Black men and women in the United States have a higher incidence of stroke than the rate among the white population in the U.S. For the first time, this study examined differences in the risk factors contributing to early stroke by race among younger adults.

The research highlights that younger individuals have a significant amount of vascular risk factors. The study examined the prevalence of three major vascular risk factors – diabetes, smoking, and high blood pressure – among younger people. One-quarter to one-half of the individuals had one or more of these risk factors, even among those who did not have strokes. The percentage of people with vascular risk factors was even higher in younger adults who had a history of stroke.

"What's important to remember about stroke is that 90 percent of strokes – across all age groups – occur due to vascular risk factors, such as smoking, drinking alcohol, lack of exercise, unhealthy diet, poorly controlled diabetes, and high blood pressure," said vascular neurologist John Cole, MD, MS, Associate Professor of Neurology, University of Maryland School of Medicine. "All of those factors, if they are identified, are fully treatable."

The study is a population-based case-control study of early-onset ischemic stroke among Black and white adults ages 15 to 49 years in the Baltimore and Washington, DC region. It included more than 1,000 cases and 1,000 controls. The population-attributable risk percentage for smoking was 19.7 percent among white men, 32.5 percent among white women, 10.1 percent among Black men, and 23.8 percent among Black women. In contrast, the population-attributable risk for high blood pressure was 17.2 percent for white men, 19.3 percent for white women, 45.8 percent for Black men, and 26.4 percent for Black women. As a result of these findings, the study's authors recommend early primary prevention efforts focused on smoking cessation and hypertension detection and treatment.

The study highlights the urgency and importance of vascular risk reduction efforts, even among younger adults. "Strokes are highly preventable. An individual's stroke risk will reduce dramatically if that individual gets rid of risk factors. Some can be treated medically, while others are lifestyle modifications," Dr. Cole said.

Of the three major risk factors that were the focus of this study, two (diabetes and hypertension) can be treated medically. The third, smoking, requires lifestyle modification. "Any amount of smoking raises your stroke risk significantly," Dr. Cole said.

The prevalence of certain risk factors was different among groups. For example, smoking was a bigger risk factor for white women, while high blood pressure was the main risk factor among Black people, particularly Black men.

"We found differences in the distribution of these risk factors among this younger age group," Dr. Cole said. "From a physician's standpoint, being cognizant of the prevalence of these risk factors among younger people – as well as the differences in prevalence by ethnicity – can help patients reduce risks and prevent stroke down the line."

For example, Dr. Cole noted that the prevalence of smoking among younger white women may have an impact on care for certain individual patients. If a patient smokes, uses oral contraceptives, and has a history of migraines, that combination is a high-risk state for stroke. "Risk factors act synergistically – they don't just add together, they multiply. Eliminating a risk factor reduces the risk caused by that individual factor, and it also reduces the synergistic risk," he said.

According to Dr. Cole, risk factor reduction is essential in the fight against stroke – and understanding the differences in prevalence among Black and white populations in the U.S. can help physicians target the highest-impact risks. "While this study focused on stroke risk, these same vascular risk factors also affect the risks of developing heart disease and peripheral vascular disease. To promote cardiovascular health across the board, optimizing these risk factors within the published guidelines is what we want to do," Dr. Cole said.

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