Strokes are increasingly affecting younger adults, challenging the assumption that cardiovascular disease is mainly a concern later in life. A new study found that stroke rates among younger adults have nearly doubled over the past three decades.

“Stroke is a very devastating disease at any age. It is particularly devastating when it happens to younger people,” said Dr. David Robinson, the study’s senior author and an assistant professor of clinical neurology and rehabilitation medicine at the University of Cincinnati College of Medicine.

Researchers examined strokes among adults ages 20 to 54 in the greater Cincinnati and northern Kentucky region. The rate climbed from 33.9 cases per 100,000 people in 1993 to 1994 to 62.2 cases per 100,000 people in 2020.

Across the period from 1993 through 2020, researchers recorded 2,076 first strokes in the population. Black individuals accounted for 738 cases, or 35.6%, while female individuals accounted for 1,030 cases, or 49.6%.

The study also found a slight increase in the number of people surviving strokes. That means more younger adults may be living with lasting effects that can complicate employment, parenting and other essential parts of daily life.

Ischemic strokes, the most common type, were primarily responsible for the overall increase. These strokes occur when blood flow to part of the brain becomes blocked.

Several established stroke risk factors also became more common during the 27 years examined. Hypertension rose from 47% to 60%, diabetes increased from 19% to 26%, atrial fibrillation climbed from 1% to 6% and substance use jumped from 5% to 40%.

Researchers said the increase in substance use was largely attributable to greater marijuana use. However, the study lacked comparable information from people who did not have strokes, so its authors could not determine whether these changing risk factors explain the rising stroke rate.

The same risk factor trends were seen among older people, yet stroke numbers did not increase in that population. Robinson said obesity, high cholesterol and a sedentary lifestyle could also contribute to stroke risk, with multiple factors potentially working together.

To reduce cardiovascular risks, Robinson pointed to the American Heart Association’s “Essential 8” checklist. Its recommendations include eating a healthy diet, being physically active, avoiding tobacco, getting quality sleep and managing weight, cholesterol, blood pressure and blood sugar.

Robinson also encouraged young adults to establish care with a primary care doctor who can screen for those measures. “It’s important to start thinking about cardiovascular health when you’re younger,” Robinson said, “because we probably have the best chance of intervening and reducing bad outcomes if we catch it early.”

Dr. Christopher Anderson, chief of the stroke division in the department of neurology at Mass General Brigham in Boston, was not involved in the research. He said earlier studies had already indicated a similar trend, making the findings concerning rather than surprising.

Anderson said the population studied had a racial background, socioeconomic status and education level that was fairly representative of the broader United States. That characteristic makes the findings more likely to apply across the country, he said.

Dr. Michelle Leppert, a vascular neurologist at Tufts Medical Center who specializes in the causes of strokes among young adults, also was not involved. She said the raw numbers remain relatively low, but greater investment is needed to understand a problem that is not improving.

Leppert said younger adults should not panic because strokes remain fairly rare events. Still, annual wellness visits can help doctors identify people at risk, while practitioners should recognize the increase and address vascular risk factors early.

Young women, who experience strokes more commonly than young men, should closely monitor blood pressure during pregnancy and after giving birth. Leppert also advised discussing migraines with visual changes with a doctor when taking birth control pills containing estrogen.

Anderson warned that high stress, poor diet, inadequate sleep and sedentary behavior can have measurable effects on stroke risk even during early and middle adulthood. The accumulating danger, he said, does not necessarily wait until retirement age to affect health.