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Stroke: No Longer a Disease of the Rich, Nor the Old

Posted on Nov 08, 2013 by Ailee Slater ()  | Tags: stroke, hemorrhagic stroke, ischemic stroke, The Lancet medical journal

When the brain doesn’t get enough blood, it loses function rapidly. Within a few moments of a blood supply cut off, the stroke victim will experience weakness in the face, difficulty moving their arms, and potentially, loss of consciousness. If blood flow is cut off for an extended period of time, difficulties in movement and speech can be long-lasting and require months of even years of rehabilitative therapy. Around the world, about 15 million people experience a stroke every year, and unfortunately, stroke is a problem that appears to be getting worse. 

According to two new studies published in The Lancet medical journal, stroke-related fatalities and disabilities could double by the years 2030. What’s more, both studies also found that stroke victims are becoming more widespread, and younger and younger. In the past, stroke primarily affected the elderly; before 1990, just one quarter of stroke patients were under age 65. Now, however, more than 31 percent of people who suffer a stroke fall into this younger age range. Why are younger people having more strokes? 

Medical researchers say that poor lifestyle choices are one major reason for the increase in youthful stroke victims. People between the ages of 20 to 64 used to have a very small chance of experiencing a blood clot and subsequent cut off of blood supply to the brain; but now, due to tobacco use, less exercise and less healthy diets, young adults are putting themselves at risk of blood clots and strokes. High blood pressure greatly increases the risk of stroke, as does high cholesterol. Therefore, a diet rich in processed red meat along with a cigarette habit can greatly increase a person’s chance of experiencing a stroke. As more and more countries around the world integrate fast food and processed meals into their diets, more incidences of stroke are likely to occur. 

Researchers also say that because recreational drug use can increase the risk of stroke, young people who use illegal drugs may be putting themselves in danger of having a stroke. In a commentary piece for The Lancet, Dr. Yannick Bejot with the University Hospital of Dijon wrote that younger adults need to be educated about the risks of stroke as they relate to the use of drugs such as marijuana and cocaine. People who take cocaine or other stimulants such as methamphetamine greatly increase their chance of stroke, especially with frequent use of those drugs.   

Clearly, stroke is not just a disease that affects the elderly. Interestingly, research from The Lancet as well as other recent studies has also poked holes in another commonly held belief about stroke: that it is a disease of the rich, or at least of those who can afford to live with very little exercise and eat a diet high in cholesterol. 

Although lifestyle choices such as lack of fitness and caloric consumption do account for a large number of stroke cases, researchers also point out that many new victims of stroke are people living in lower-income countries who experience a hemorrhagic stroke. This type of stroke does not occur because of a clot and blockage of blood. Instead, during a hemorrhagic stroke, a blood vessel in the patient’s brain will burst, leaking blood onto the surrounding brain tissue. A hemorrhagic stroke is less common than an ischemic stroke, wherein clotting of the arteries leads to a build-up of plaque and the eventual blockage of blood to the brain. Both types of stroke can cause serious damage, but a hemorrhagic stroke is more fatal. Whereas an ischemic stroke temporarily deprives the brain of oxygen, a hemorrhagic stroke can cause serious and irreversible damage to the tissue of the brain. 

Researchers are not yet sure why hemorrhagic stroke occurs more often in developing as opposed to developed countries, but they do have some theories. In a 2006 World Health Organization (WHO) report on cerebrovascular disease, researchers pointed out that hemorrhagic stroke seems to be related to blood pressure and cholesterol in a unique and inverse way: when a person has high blood pressure but low cholesterol, a hemorrhagic stroke appears more likely to occur. People in low-income countries have less access to blood pressure medication, while at the same time tend to eat diets that are low in cholesterol. It’s possible that when combined, these two factors are leading to greater hemorrhagic stroke susceptibility in developing countries. 

The WHO report on cerebrovascular disease found that in high-income countries, hemorrhagic stroke accounts for 15 percent of all stroke cases, wherein in low- and middle-income countries, around 30 percent of strokes will be hemorrhagic. Because hemorrhagic stroke is also made more likely by risk factors such a smoking and tobacco use, this type of stroke may increase in low-income countries in the future: if blood pressure medication remains inaccessible, diets stay low in cholesterol and use of tobacco increases, all evidence shows that hemorrhagic stroke will become more common. In fact, it already has. The Lancet studies showed that since 1990, incidences of hemorrhagic stroke in the developing world have increased by around 19 percent. 

This research from The Lancet and the World Health Organization indicates that in the future, stroke education and prevention efforts should be directed toward young adults as well as the elderly, and toward low-income as well as high-income nations. As long as the myth persists that young people are safe from stroke, or that it’s a disease which can only affect people with high-cholesterol diets, incidences of both types of stroke are likely to grow.


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