Stroke is not just an older person’s problem: rising stroke rates among under-55s and actionable risk factors

Stroke in young adults: a growing concern

Stroke is no longer just an older-person's problem. This article highlights rising stroke rates among people under 55 and shows how modifiable risk factors and rapid treatment can change outcomes. Author: Stroke Association.

• Under-55 stroke incidence has risen in several regions while older-age rates have fallen.
• Most strokes in young people are linked to modifiable risk factors such as high blood pressure, physical inactivity, high cholesterol, obesity, smoking, diabetes, and alcohol use.
• High blood pressure accounts for nearly half of strokes in people 55 and under; regular exercise explains a large portion of avoidable risk.
• Speed matters in treatment; clot-busting therapy is most effective when delivered promptly after symptom onset.

Overview

Stroke is increasingly recognized as a problem that affects younger adults as well as older people. The article presents data from multiple countries showing that while stroke incidence in older populations has declined, rates among those under 55, and particularly under 40 in some regions, have risen. In England, incidence among 35- to 54-year-olds rose by about 2% per year from 2001 to 2010, even as overall stroke rates fell. In Oxfordshire, under-55 rates between 2010 and 2018 were roughly 90% higher than in 1981–1986, while rates in older people fell. In the US, stroke rates in 20- to 54-year-olds increased from 34 to 62 cases per 100,000 people per year between 1993–1994 and 2020. Globally, about 2.8 million people under 55 had a stroke in 2021, with nearly 90% in low- and middle-income countries, and rates of ischaemic stroke among 20- to 39-year-olds are projected to rise by about 12% from 2020 to 2030.

What is fuelling the rise?

The rise in strokes among young people appears largely driven by modifiable factors. A large international study identified ten modifiable risk factors accounting for around 92% of strokes in people under 55. These factors include high blood pressure, physical inactivity, high cholesterol, poor diet, obesity, smoking, heart problems, diabetes, alcohol consumption and psychosocial factors such as stress or poor mental health. High blood pressure alone accounted for almost half of strokes in those 55 and under, and lack of regular exercise explained more than a third of cases.

A UK study of 1,765 people aged 18–49 who were hospitalized for stroke found 42% had high blood pressure, 24% high cholesterol, 23% smoked, 14% had diabetes and about 7% reported recreational drug use. Obesity and diabetes have been rising in younger people for three decades and are often undiagnosed or undertreated in younger adults. Even among those with risk factors, left untreated these conditions can quietly raise stroke risk. Not all strokes have a clear cause, and an increasing number of strokes in young people have no known risk factor; researchers are exploring alternative risks such as air pollution, autoimmune conditions and illicit drug use, along with stress and overworking.

Signs young people miss

Stroke in younger adults can be harder to recognize. A large US analysis found that the 18–44 age group was most likely to be discharged from emergency departments with a missed stroke, often presenting with dizziness or headache. The Stroke Association survey reported that a quarter of survivors aged 60 and under were initially misdiagnosed. In younger people, signs can differ from the classic facial droop, arm weakness, and speech difficulty; strokes at the back of the brain can affect balance and vision, causing headaches or vertigo. If symptoms appear, medical help should be sought immediately, as clot-busting treatment is generally most effective within 4.5 hours of onset.

The signs young people miss

The signs of a stroke in younger individuals may differ from older patterns. Back-of-brain strokes affect balance and vision more than the face or limbs, and symptoms may include headache, neck pain or vertigo. People, and even healthcare workers, may mistake these symptoms for migraines, tiredness, or inner-ear problems, and episodes can be transient. However, any stroke-like symptoms warrant urgent assessment.

What you can do

The good news is that most strokes in younger people are linked to modifiable factors. The first step is to know your blood pressure and have regular checks for diabetes and high cholesterol, especially if you are overweight or have a family history of heart disease or stroke. Lifestyle factors matter too: don’t smoke, avoid recreational drugs, and limit alcohol to no more than 14 units per week. Salt intake should be no more than 6 g per day, and a higher fiber intake can help keep blood pressure and cholesterol down. Exercise is key: aim for at least 150 minutes of moderate activity per week. Stress and long working hours have been linked to higher stroke risk, independent of other risk factors. Overall, stroke is no longer exclusively an older person’s problem, and awareness plus swift action can save lives.

Obesity and diabetes, along with high blood pressure, are increasingly common among younger adults and are often undiagnosed. The article emphasizes the importance of public awareness, routine screening, and lifestyle modification as primary strategies to reduce stroke incidence in younger populations.