Stroke Facts: Higher Rates in Young Adults, and COVID-19 Clotting

Studies indicating higher stroke rates among U.S. adults younger than 55 started surfacing many years ago, long before the COVID-19 pandemic. Now, reports of strokes in young and middle-aged COVID-19 patients have emerged, the direct consequence of blood problems that are producing clots in these patients. 

But the numbers of COVID-19 patients affected by strokes appear to be small and should not panic the public, says Felipe De Los Rios, M.D., Medical Director, Stroke Program at Miami Neuroscience Institute, part of Baptist Health South Florida.

“We will need more studies, larger studies with multiple centers, to try to grasp the magnitude of that increased stroke risk,” says Dr. De Los Rios. “It’s most likely not very large. The vast majority of people are not going to have a stroke associated with COVID-19.” (Listen to Dr. De Los Rios via Baptist HealthTalk on your computer or smartphone, or on Apple Podcasts and Google Podcasts.)

Higher Stroke Rates in Those Under 55

Studies of strokes in COVID-19 patients are just gettingstarted, but previous research has indicated that young and middle-aged adultsare increasingly suffering from strokes, possibly the result of more adultsunder 55 having well-known stroke risk factors, including high blood pressure,diabetes and high cholesterol. The nation’s obesity epidemic is likely a big factor,as is smoking and sedentary lifestyles. 

However, as Dr. De Los Rios points out, the most troublingaspect of the increasing stroke rate among young adults is that more thanone-third of these cases have unknown underlying causes.

“In about 40 percent of these young adults, we don’tknow what caused the stroke, so all the tests come back negative and that’s alarge percentage,” says Dr. De Los Rios. “So, it’s hard for us to sayfor sure what is driving that increase in young adults when there is so muchthat’s unknown. It’s so big that more research is required.”

Between 1995-1999 and 2010-2014, studies have found thatstroke rates more than doubled (a 2.47-fold increase) in people 35 to 39 yearsold; doubled in people aged 40 to 44; and increased to a lesser extent inpeople 45 to 54 years old.

Stroke can be caused either by a clot obstructing the flowof blood to the brain (called an ischemic stroke) or by a blood vesselrupturing and preventing blood flow to the brain (called a hemorrhagic stroke).It is the No. 5 cause of death and a leading cause of disability in the UnitedStates. When a stroke occurs, part of the brain cannot get the blood (andoxygen) it needs, so brain cells die. (May is Stroke Awareness Month)

Fighting Infections

It is not unusual for patients hospitalized with severe fluor other types of serious infections to be at a higher risk for stroke — as ishappening in some COVID-19 patients, says Dr. De Los Rios.

“We know from previous research that people can be at ahigher risk of stroke just because the body is fighting an infection and peopleare not moving, lying still in bed and all of that increase the possibility ofclot formation,” explains Dr. De Los Rios. “That’s something that weknow happens in general, irrespective of the (infectious) agent. We know from previousstudies done with other influenza-like illnesses, or epidemics, that there isan increased risk of stroke, especially with younger adults. So that’ssomething we also already know. What we still don’t know is if it is higherwith COVID-19, compared to other viruses.”

The bottom line, he says, people who have underlying riskfactors, such as high blood pressure, should continue taking their medications,follow a heart healthy diet and exercise whenever possible. And never ignorethe signs of a stroke, covered by the acronym F.A.S.T.

“If there is a concern that someone is having a stroke,they really should go to the hospital to get treated as fast as possiblebecause we have time-dependent treatments that can really change the outlookfor someone with a stroke and prevent long-term disability,” said Dr. DeLos Rios.

Signs of a Stroke

Here are the top signs of a stroke, according to theAmerican Stroke Association:

F – Face Drooping: Does one side of the face droop or is itnumb? Ask the person to smile. Is the person’s smile uneven?

A – Arm Weakness: Is one arm weak or numb? Ask the person toraise both arms. Does one arm drift downward?

S – Speech Difficulty: Is speech slurred? Is the personunable to speak or hard to understand? Ask the person to repeat a simplesentence, like “The sky is blue.” Is the sentence repeated correctly?

T – Time to call 9-1-1: If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.