Neurologists around the world are warning of an increase in strokes in young people. Although stroke has historically been associated with old age, the most recent data show that the trend is changing rapidly and worryingly.
This epidemiological shift requires understanding the new causes of stroke in young people and adapting prevention strategies. Understanding the problem now is key to avoiding a much greater future social and economic burden.
A worrying trend: more strokes among young people
A global analysis published in The Lancet Neurology showed that, from 1990 to 2021, the incidence of stroke in people under 55 years of age increased, while in older people it stagnated. Among young people, the increase was most notable in low- and middle-income countries.
A CDC report revealed that adults between 45 and 64 years of age experienced a 15% increase in the prevalence of stroke between 2011 and 2022; In the 18-44 age group, the increase was 14.6%.
According to the review published in the Journal of Clinical Medicine, strokes in those under 50 now represent 10-14% of all strokes in the United States and Europe, with a steady upward trend.
Uncontrolled hypertension explains much of the phenomenon. A cross-sectional study using NHANES data found that 83.7% of hypertensive adults in the US maintain levels above 130/80 mmHg, with those under 45 being the least aware of their condition (Richardson et al., 2024).
Why is the risk increased?
Uncontrolled hypertension
High blood pressure is the strongest individual determinant of stroke. When it begins in the third decade of life, vascular damage accumulates over more years, multiplying the absolute risk before the age of 50.
The lack of medical follow-up in young people explains the increase in strokes in young people; half of patients under 44 years of age with hypertension are unaware of their diagnosis and therefore do not receive adequate treatment (Richardson et al., 2024).
Obesity and Metabolic Syndrome
The prevalence of obesity has doubled in adults aged 18-39 since 1999. Visceral adiposity promotes inflammation, dyslipidemia, and insulin resistance, a triad that accelerates cerebral atherosclerosis.
The GBD2021 attributes an 88% increase in disability-adjusted life years to a high body mass index. The metabolic epidemic directly impacts the causes of stroke in young people.
Smoking and Substance Use
Although the overall smoking rate is declining, vaping and electronic devices reintroduce nicotine at early ages. Chronic exposure damages the arterial intima and enhances blood clot formation.
Furthermore, recreational use of cocaine, amphetamines, and synthetic cannabis acts as a trigger for vasculitis and hypertensive crises, direct drivers of hemorrhagic stroke in young adults.
Specific Causes of Stroke in Young People
Migraine with Aura
People who suffer from migraine with aura have double the risk of ischemic stroke. It is postulated that cortical depression induces endothelial dysfunction and facilitates platelet aggregation (Bukharie et al., 2023).
The risk increases when oral contraceptives or smoking coexist; recognizing this association allows for early intervention with preventive therapies and health education.
Pregnancy and Contraceptives
Pregnancy increases blood volume and coagulability, while the postpartum period is associated with hemodynamic fluctuations. Both periods increase the likelihood of stroke threefold compared to non-pregnant women.
Combined estrogen-progestin contraceptives may double the risk, especially in the presence of migraine with aura or thrombophilia, reasons that underscore the demand for individualized counseling.
Heart Disease and Patent Foramen Ovale
Up to one-third of cryptogenic strokes in patients under 55 years of age are associated with patent foramen ovale (PFO). The paradoxical passage of emboli from the venous circulation explains unexpected arterial occlusions in brains without atherosclerosis.
Echocardiographic detection and percutaneous closure of PFOs have been shown to reduce recurrences, constituting an example of precision medicine in vascular neurology.
Arterial Dissection and Cervical Trauma
High-intensity exercise, chiropractic manipulations, or minor accidents can tear the intima of carotid and vertebral arteries. Dissection is the leading cause of arterial stroke in patients under 45 years of age.
Early diagnosis by CT angiography or MRI and early anticoagulation are crucial to prevent extensive infarcts of the brainstem or carotid territory.
Autoimmune Diseases and Coagulation Disorders
Systemic lupus erythematosus, antiphospholipid syndrome, and sickle cell anemia increase platelet aggregation and thrombus formation. Young people with these conditions require close neurological monitoring.
The Role of the Environment and Social Inequalities
Education and Socioeconomic Status
The CDC study found that people without a high school education experienced the highest percentage increase in strokes. Lack of education limits access to preventive information and quality healthcare resources.
Pollution and Thermal Stress
Prolonged exposure to PM2.5 particles is associated with systemic endothelial dysfunction. The GBD2021 study found a 72% increase in the burden attributable to extreme ambient temperatures, a phenomenon that is particularly severe in dense urban environments.
Access to Care and Diagnostic Delay
In rural populations, young people take longer to recognize symptoms and reach centers with stroke units. The therapeutic window is lost, and the after-effects worsen, perpetuating the cycle of disability and poverty.
Multidimensional consequences of stroke in young people
Surviving a stroke before the age of 40 means living with motor deficits, aphasia, or epilepsy for productive decades. The psychological impact includes depression, anxiety, and alterations in work identity.
The economic cost includes prolonged rehabilitation, loss of family income, and increased public healthcare spending. Each disability-adjusted life year in a young person generates a much greater social burden than at older ages.
Families assume long-term caregiving roles, with emotional and financial repercussions that extend to children and partners, reinforcing the urgency of preventive measures.
What can we do to prevent it?
Incorporating routine blood pressure and lipid profile measurements in late pediatric visits detects risk factors before the age of 30 and allows for early pharmacological interventions.
Promoting plant-based diets, daily physical activity, and smoke-free environments reduces systemic inflammation and improves metabolism; schools and workplaces are key settings.
Mobile brain health apps monitor blood pressure, heart rate, and medication reminders, bringing monitoring closer to digitalized populations with little healthcare contact.
In conclusion
The increase in strokes in young people is an indicator that the epidemiological transition is progressing faster than expected and that classic risk factors are manifesting at increasingly earlier ages.
Understanding the multiple causes of stroke in young people—from hypertension and obesity to migraine with aura or arterial dissection—allows for the design of targeted and personalized prevention strategies.
Acting now with evidence-based policies, health education, and equal access to health care is the best guarantee to reverse the trend and protect new generations from avoidable disability.
