Over the past decade, ischemic strokes have been decreasing among older people. During that period, however, such strokes have been increasing among young and middle-aged adults. Here’s what may be driving this alarming trend…and steps that help reduce stroke risk.

Increasing age is a prime factor in risk for ischemic stroke, the kind caused by blockage of an artery that supplies blood to the brain. However, up to 14% of such strokes occur in people ages 18 to 45. While a stroke at any age is a major life-changer, having a stroke in the prime of life can be much worse than having one in your 70s or 80s. A debilitating stroke during what should be the most productive years can have a devastating impact physically, emotionally and financially not just on the stroke patient but to young families.

In older adults, research has found that stress can be a triggering factor for both ischemic stroke and transient ischemic attack (TIA)—a “ministroke” that lasts only minutes or seconds and is often a warning for full stroke. But it has not been known whether stress also makes young people vulnerable to stroke.

To learn more about the effect of stress on stroke risk in young adults, researchers at University of North Carolina School of Medicine looked at a prevalent form of severe stress in that age group, post-traumatic stress disorder (PTSD). PTSD can result from many kinds of emotional trauma, including sexual assault, exposure to gun violence and being involved in warfare. Because PTSD is especially common among veterans, the researchers looked at incidence of stroke and TIA in 13 years of Veterans Administration medical records for about one million veterans (90% of them were men) who had been deployed to Iraq or Afghanistan after 9/11.

Study: There were 766 TIAs and 1,877 ischemic strokes over the course of the study, and about 30% of the vets were diagnosed with PTSD. Average age was about 43 at the time of their stroke or TIA.

Results: After adjusting for other stroke and TIA risk factors—such as diabetes, high blood pressure, smoking, obesity, alcohol/drug abuse, depression and generalized anxiety disorder—vets with PTSD had a 61% higher risk for TIA and a 36% higher risk for stroke than vets without PTSD. Gender did not influence risk for TIA, but risk for stroke was significantly higher in men than women.

How Might Stress Cause TIA and Stroke?

Although exactly how stress may trigger stroke is not fully understood, the researchers believe that one reason may be that stress is a well-known trigger for inflammation throughout the body. Inflammation causes physical changes that increase the likelihood of blood to clot and arteries, including those that carry blood to the brain, to narrow, contributing to chances of a blockage.

PTSD is an extreme form of stress. But this study, the first to find a link to stroke in young adults, suggests that other types of stress may also boost stroke risk in this age group. The researchers also point out that this research supports another large study, the INTERHEART study, which found that general stress, stressful life events and even financial stress may affect younger adults more than older adults—and increase their risk for stroke.

While more research is needed, the study authors hope that better screening for PTSD and other kinds of intense emotional stress and targeted counseling and appropriate therapies will help reduce stroke among young adults.