6 Things to Know About Stroke in Young Patients

Although there is evidence that stroke-related deaths are on the decline, the number of strokes occurring in young patients is on the rise.

The American Heart Association (AHA) recently published a 2016 update of heart disease and stroke statistics in Circulation. According to the AHA, every 40 seconds, an American has a stroke, and every 4 minutes, a US patient dies from a stroke.

Historically, stroke had been the fourth-leading cause of death in the country, but in 2013, it fell to the fifth spot, following heart disease, chronic lower respiratory diseases, and unintentional injury.

Between 2003 and 2013, the relative rate of stroke-related death decreased by 33.7%, according to the AHA. In addition, the number of stroke-related deaths fell by 18.2% in that time period.

Still, close to 800,000 individuals have an ischemic or hemorrhagic stroke each year. Around 610,000 of those cases are first-time strokes, and about another 185,000 are second-time strokes.

The AHA report authors pointed out that the improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. For example, there have been successful efforts to control hypertension, diabetes, and high cholesterol, plus an increased focus on smoking cessation, over the last couple decades.

Pharmacists can help educate patients on the risk factors for stroke, as well as the signs.

The American Stroke Association advises patients to call 911 if they experience the following symptoms: numbness or weakness in the face, arm, or leg (especially if it is on 1 side of the body); trouble speaking, understanding, talking, or walking; and severe headache.

Pharmacists can also recommend that patients who have had a stroke or transient ischemic attack (TIA) take aspirin as initial therapy to prevent another episode. However, pharmacists should advise patients that they should not increase their dose of aspirin if they experience a recurrent stroke or TIA while on the aspirin therapy.

Because young patients’ incidence of stroke is on the rise, here are 5 facts pharmacists should know about stroke in this population.

1. Hospitalizations for ischemic stroke are increasing among young patients.

According to National Health Interview Survey data, hospitalizations for ischemic stroke increased between 1995 and 2008 among patients aged 5 to 44 years, though subarachnoid hemorrhage hospitalizations decreased in that time frame.

Around 1 in 10 strokes occur in patients aged 18 to 50 years.

2. Stroke-related death rates are improving among elderly patients more than younger patients.

Stroke-related death rates are seeing greater strides among patients aged 65 years or older than those aged 45 to 64 years and those aged 18 to 44 years, according to the AHA.

One study that found that between 2000 and 2010, ischemic stroke rates declined significantly among patients aged 60 years or older but remained stable among those aged 45 to 59 years.

3. Stroke prevalence is expected to grow.

Experts believe that 3.4 million more individuals aged 18 years or older will have experienced a stroke by 2030, which represents a 20.5% increase in prevalence from 2012.

Hispanic men in particular will face significant increases in stroke prevalence, according to the AHA.

4. Ischemic stroke is the most common stroke type among young patients.

The 2005 Greater Cincinnati/Northern Kentucky Stroke Study found that ischemic stroke was the most common stroke type seen among those aged 20 to 54 years, as more than 68% of strokes were ischemic in this patient population.

Intracerebral hemorrhage was the next most common stroke type (16.9%), followed by subarachnoid hemorrhage (9.8%). An unknown pathogenesis was listed in 4.7% of cases, according to the study.

5. Hypertension and smoking are major risk factors for stroke in young patients.

The Greater Cincinnati/Northern Kentucky Stroke Study also found that hypertension was prevalent in 52% of stroke cases among patients aged 20 to 54 years, while current smoking was prevalent in 46% of cases.

Diabetes (20%), hyperlipidemia (18%), and congenital heart defect (12%) were other common vascular risk factors for stroke.

6. Children may face a temporary increased risk for stroke after colds, flu, or minor infections.

One study published in Neurology examined around 350 children younger than 18 years who had experienced a stroke. They found that 18% of the children had experienced a cold or some kind of infection in the week prior to the stroke.

The study also found that routine childhood vaccinations may help prevent stroke.