Pre-Halloween scare about strokes in young people

Be alarmed. Be very alarmed. A recent study in the journal Neurology reveals an increasing rate of strokes in young people. Though the overall stroke rate remains low compared to older folks, stroke rates are still climbing in a concerning fashion. For the purposes of this study, “young” was defined as those ages 20 to 54. I can accept that definition. According to the authors, I am only about seven years past being young.

What did the study show? Among African American young people, the rate of stroke increased from 83 per 100,000 in 1993-94 to 128 in 2005, higher by 54%. For Caucasians, the rate increased from 26 to 48, an increase of 84%.

While the increasing stroke incidence among the young is surprising, the cause is not mysterious. The young people having strokes suffered from the same risk factors as older folks – diabetes, hypertension, vascular disease, and smoking. It is especially concerning that young African Americans have almost three times the risk of strokes.

The increase in strokes in the young parallels the increase in other diseases they formerly seemed relatively exempt from, especially type 2 diabetes and obesity. Across the board, young people seem to be growing less healthy as the years go by.

As you have probably heard, some public health experts are predicting a decline in longevity in the U.S., which would be a sea change for this country. The reasons are multifaceted and the problems are complex. Though we each need to do the best we can to help our patients modify their risk factors, the problems cannot be completely remedied in the individual office visit, working one-on-one with each patient. We physicians are fighting an uphill battle against the ubiquitous fast food franchises, tobacco and alcohol advertising and availability, increasing portion sizes in restaurants, sugar in soft drinks, the increasing popularity of video games over going outside to exercise, elimination of phys ed classes from schools, poor availability of safe parks in many neighborhoods, parental examples which are not always optimal, etc.

None of this exempts us from continuing to working with our own patients on risk factor modification. But we need support from government and public health officials, faith leaders, the food industry, schools, and other community leaders. We’re all in this together.

Richard Fleming, MD

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