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Stroke: It’s On the Rise Among Younger People

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Unfortunately, only about 20% to 30% of them go to the ER…

Few people in their 40s or 50s can imagine having a stroke, particularly if they are generally healthy. But the risk is higher than you might think—dispelling the common belief that stroke is a risk for only the elderly.

An unexpected trend: Over the last several years, there has been an increase in strokes among adults in their 40s, 50s and 60s. What’s most alarming about this development is that doctors don’t expect to see strokes in these relatively young patients, so the diagnosis sometimes gets overlooked.

Important finding: One in seven young stroke patients was initially misdiagnosed as having another problem, such as a seizure or alcohol intoxication, researchers at Wayne State University–Detroit Medical Center found in a recent study.

What to do: First and foremost, be alert. Stroke can occur at any age, so it’s important for all adults to pay close attention to symptoms. If you are diagnosed and treated within about four hours of having a stroke, you are far more likely to recover than someone whose diagnosis and treatment are delayed. Unfortunately, only about 20% to 30% of young patients with stroke symptoms go to the emergency room, according to research. The others are likely to shrug off the symptoms (especially if they were relatively minor and/or short-lived) and do not learn that they have suffered a stroke until a subsequent problem is detected later on.

WHAT’S CAUSING EARLIER STROKES?

Many of the so-called “age-related” diseases that greatly increase stroke risk, such as high blood pressure (hypertension), diabetes and high cholesterol, are now appearing in patients who are middle-aged or younger—primarily because so many Americans are eating more junk food, gaining too much weight and not getting enough exercise. Family history is also a risk factor for stroke.

But even if you don’t have any of these conditions (or a family history of stroke), you are in good physical shape and generally eat a well-balanced diet, do not be lulled into a false sense of security. Anyone can suffer a stroke. That’s why it’s very important for all adults to be on the lookout for red flags that could signal a stroke.

PREVENTION WORKS

Stroke is the fourth-leading cause of death in the US. Those who survive a stroke often face a lifetime of disability, including paralysis and speech and emotional difficulties.

Fortunately, younger patients, in general, are more likely to recover than older ones because their brains have greater plasticity, the ability to regain functions after stroke-related trauma. Even so, many young stroke patients will have permanent damage.

Important: Regardless of your age, fast treatment is critical if you experience stroke symptoms. The majority of strokes are ischemic, caused by blood clots that impair circulation to the brain. Patients who are given clot-dissolving drugs, such as tissue plasminogen activator (tPA), within the first few hours after a stroke are far more likely to make a full recovery than those who are treated later.

Up to 80% of strokes can be avoided by preventing or treating the main risk factors, according to the National Stroke Association. For example, not smoking is crucial—people who smoke are twice as likely to have an ischemic stroke as nonsmokers.

Also important…

Do not ignore hypertension. Like stroke, hypertension is often viewed as a problem only for the elderly. But there’s been an increase in hypertension in younger patients, who often go undiagnosed.

Warning: Uncontrolled high blood pressure damages the brain—even in patients who haven’t had a stroke, according to a new study published in The Lancet Neurology.

If your blood pressure is high (normal is below 120/80), you are two to four times more likely to have a stroke than someone with normal blood pressure.

What to do: All adults should always have their blood pressure taken during routine doctor visits (at least once every two years if your blood pressure is normal…and at least annually if you’ve been diagnosed with hypertension or prehypertension). You can reduce both blood pressure and the risk for stroke by maintaining a healthy body weight…eating a healthful diet…getting regular exercise…and taking medication if your blood pressure remains elevated despite lifestyle changes.

Manage diabetes. It’s second only to hypertension as a risk factor for stroke. Diabetes increases the risk for all cardiovascular diseases, including hypertension. People who have diabetes are up to four times more likely to have a stroke than those without the condition.

What to do: Get tested. The American Diabetes Association recommends that all adults age 45 and older get screened for diabetes every three years.

If you already have diabetes, do everything you can to keep your blood sugar stable—for example, eat properly, get exercise and lose weight, if necessary.

Keep an eye on your cholesterol. It’s the third most important stroke risk factor because LDL (“bad”) cholesterol can accumulate in the arteries, impede circulation to the brain and increase the risk for blood clots.

What to do: Beginning at age 20, get your cholesterol tested at least every five years. If your LDL is high (less than 100 mg/dL is optimal), you’ll want to get the number down by eating less saturated fat…getting more vegetables and other high-fiber foods…and possibly taking a statin medication, such as simvastatin (Zocor). Depending on the drug and dose, statins typically lower cholesterol by about 25% to 50%.

Pay attention to your alcohol consumption. People who drink heavily (three or more alcoholic beverages daily for men and two or more for women) are more likely to have a stroke earlier in life than moderate drinkers or nondrinkers.

In fact, in a study of 540 stroke patients, French researchers found that heavy drinkers suffered their strokes at age 60, on average—14 years earlier than patients who drank less or not at all.

Warning: Heavy use of alcohol is also associated with increased risk for hemorrhagic stroke, which is caused by bleeding in the brain (rather than a blood clot). This type of stroke can occur even in patients without a history of serious health problems.

What to do: If you drink, be sure to follow the standard advice for alcohol consumption—no more than two drinks daily for men…or one for women.

SURPRISING RED FLAGS FOR STROKE

Stroke symptoms aren’t always dramatic. If you’ve had a minor stroke or a transient ischemic attack (a brief interruption of blood flow known as a “ministroke”), the symptoms might be fleeting and easy to miss.

What’s more, in rare cases, symptoms may occur that you may not think of in relation to a stroke. For example, you may initially feel disoriented or experience nausea, general weakness, face or limb pain, chest pain or palpitations—all of which typically come on suddenly. Depending on the part of the brain that’s affected, you may not be aware of your symptoms and must rely on someone else to call for help.

Don’t take chances. Get to an emergency room if you have these and/or the classic symptoms below—FAST (Face, Arm, Speech and Time) is a helpful guide.

Face: The most common stroke symptom is weakness on one side of the body, including on one side of the face. You may have difficulty smiling normally.

Arm: One-sided weakness often affects one of the arms. Hold both arms out to your sides. You could be having a stroke if one of your arms drops down.

Speech: Your words could sound slurred, or you might be unable to say a simple sentence correctly.

Time: In the past, the “window” to receive clot-dissolving medication was considered to be three hours. New research indicates that stroke patients can benefit if they get treated within 4.5 hours after having the first symptom.

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Source: Brett M. Kissela, MD, professor and vice-chair of the department of neurology at the University of Cincinnati College of Medicine. He was the lead researcher of the National Institutes of Health–funded study, published in Neurology, that documented increasing strokes in younger adults. He specializes in stroke treatment and prevention and the role of diabetes and elevated glucose on stroke risks and outcomes. Date: January 1, 2013 Publication: Bottom Line Health
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