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

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May 13, 2020

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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 getting started, but previous research has indicated that young and middle-aged adults are increasingly suffering from strokes, possibly the result of more adults under 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 troubling aspect of the increasing stroke rate among young adults is that more than one-third of these cases have unknown underlying causes.

“In about 40 percent of these young adults, we don’t know what caused the stroke, so all the tests come back negative and that’s a large percentage,” says Dr. De Los Rios. “So, it’s hard for us to say for sure what is driving that increase in young adults when there is so much that’s unknown. It’s so big that more research is required.”

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

Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing 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 United States. When a stroke occurs, part of the brain cannot get the blood (and oxygen) it needs, so brain cells die. (May is Stroke Awareness Month)

Fighting Infections

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

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

The bottom line, he says, people who have underlying risk factors, such as high blood pressure, should continue taking their medications, follow a heart healthy diet and exercise whenever possible. And never ignore the 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 possible because we have time-dependent treatments that can really change the outlook for someone with a stroke and prevent long-term disability,” said Dr. De Los Rios.

Signs of a Stroke

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

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

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

S – Speech Difficulty: Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, 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.

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