Strokes are rising dramatically among young and middle-aged Americans while dropping in older people, a sign that the obesity epidemic may be starting to shift the age burden of the disease.
The numbers, reported at an American Stroke Association conference, come from the first large nationwide study of stroke hospitalisations by age. Government researchers compared hospitalisations in 1994 and 1995 with ones in 2006 and 2007.
The sharpest increase — 51 per cent — was among men 15 through 34. Strokes rose among women in this age group, too, but not as fast — 17 per cent.
“It’s definitely alarming,” said Dr. Ralph Sacco, American Heart Association president and a neurologist at the University of Miami. “We have worried for a while that the increased prevalence of obesity in children and young adults may take its toll in cardiovascular disease and stroke,” and that appears to be happening, he said.
Stroke still takes its highest toll on older people. For those over 65, there were nearly 300 stroke cases among 10,000 hospitalisations in the more recent period studied. For males 15 to 34, there were about 15 stroke cases per 10,000, and for girls and women in that age group there were about 4 per 10,000.
Several small studies had recently suggested an ominous rise among the young and among middle-aged women.
“We were interested in whether we could pick that up in a much larger, nationwide dataset,” said Dr. Mary George, a stroke researcher at the US Centres for Disease Control and Prevention.
The researchers examined federal records from a sample of hospitals in 41 states, covering about 8 million cases each year. They looked at the percentage of all hospitalisations for stroke by gender and in six age groups.
For every 10,000 hospitalisations in 1994-95 compared with 2006-07, strokes rose:
υ 51 per cent, from 9.8 to 14.8, among males 15 to 34 years old
υ 17 per cent, from 3.6 to 4.2, in females 15 to 34
υ 47 percent, from 36 to 52.9, in males 35 to 44
υ 36 percent, from 21.9 to 30, in females 35 to 44
“The increases seen in children are very modest, but they are more so in the young adult age groups, and we feel that deserves further study,” George said.
Better awareness of stroke symptoms and better imaging methods for detecting strokes in young people could account for some of that change, but there is no way to know, she said.
Trends went the opposite way in older people. Strokes dropped 25 per cent among men 65 and older (from 404 to 303 per 10,000 hospitalisations), and 28 per cent among women in this age group (from 379 to 274). Doctors think better prevention and treatment of risk factors such as high blood pressure in older people may be contributing to the decline.
At the University of California at Los Angeles, doctors are seeing more strokes related to high blood pressure and clogged arteries in younger people, said Dr. Jeffrey Saver, director of the stroke center at UCLA.
Allison Hooker, a nurse who coordinates stroke care at Forsyth Medical Center in Winston-Salem, N.C., said her hospital also is seeing more strokes in younger people with risk factors such as smoking, obesity, high blood pressure, alcohol overuse and diabetes.
“I’d say at least half of our population (of stroke patients) is in their 40s or early 50s,” she said, “and devastating strokes, too.”
Also at the conference:
A preliminary study raised concern about diet soda and stroke risk. Researchers surveyed about 2,500 adults in the New York City area at the start of the study and followed their health for nearly 10 years afterward. Researchers found that people who said they drank diet soda every day had a 48 per cent higher risk of stroke or heart attack than people who drank no soda of any kind.
The same study also found higher risks for people consuming more than 1,500 milligrams of salt a day — the limit the American Heart Association recommends. Researchers found that stroke risk rose 16 per cent for every 500 milligrams of salt consumed each day. Those who took in at least 4,000 milligrams had a more than 2.5 times higher risk than those who limited themselves to 1,500 milligrams.
Marilynn Marchione (AP)