Dr. Kelvin Owusu writes: Stroke strikes the young too

If you are a fan of any of the TV medical drama series, you must have come across this pneumonic, I know I heard it first on ‘House’ sometime before my final exam in medical school, and boy was it helpful. Imagine getting help in your MBCHB Final Part 2 from Dr. House… now that’s quite a story. But let’s get right back to the script now.

This mnemonic has saved many lives by drawing attention to the subtle signs of early stroke, and has led to significant improvement in survival following a stroke.

But what if you were not on the lookout for stroke in the first place, would the mnemonic make a difference?

Many people have associated strokes with age, and would not suspect it even if all the symptoms were staring them in the face with a flag that said ‘I am getting a stroke!’.

Yes, the risk of stroke increases with age, but it is also possible to get a stroke at any age, from infancy through childhood to young adulthood and beyond.

Let us start with a basic understanding of stroke.

What is stroke?

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells in the affected area begin to die, resulting in the symptoms that we observe.

A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimise brain damage and potential complications.

Fact; even though generally speaking the number of strokes is reducing, research has shown that the number of people under 55 getting strokes is on the increase. The mean age of stroke dropped from 71.2 years in 1993 to 69.2 years in 2001, whilst the number of strokes under 55 rose from 13% to 19% in the same period.

Of course, technological advancements in imaging have improved the early detection of strokes and this may account for the increasing numbers of detection in the younger age groups, however, all the risk factors associated with strokes have seen a significant increase in the last few decades.

This brings us to the discussion on risk factors for stroke.

What are the risk factors for stroke and how have they changed over time?

The risk factors for stroke are either modifiable or non-modifiable.

As the name implies, non-modifiable risk factors are the ones that you can not do anything about, such as,

Age – the older you are, the higher the probability.

Sex – men are more at risk than women

Race – Blacks are more at risk

Modifiable risk factors… now that’s a whole other discussion.

Hypertension

High blood pressure or hypertension is the single most important independent risk factor for the development of stroke responsible for up to 50% of all strokes.

The sustained increase in blood pressure puts a strain on the blood vessels causing weakening and injury to the vessels which makes them more likely to be blocked by a clot resulting in a stroke. Hypertension is now a major health concern in Ghana with prevalence ranging from 19% to 48% between studies.

Diabetes

People who have diabetes are two to four times more likely to have a stroke than people who do not have diabetes.

Diabetes is a result of a lack of insulin production (type 1) or inadequate production or inefficient utilization of insulin (type 2). The impaired glucose metabolism leads to a build-up of fatty acids in the blood vessels, resulting in blockages. If the vessels in the head and neck are involved, you could develop a stroke.

Prevalence of diabetes is also on the increase, with an estimated 4 million Ghanaians living with it, a significant number of young adults included.

Obesity

The prevalence of obesity is on the rise in all age groups. It has risen from 14% to over 30% over the past century. In Ghana, we do not have much data, however, a cursory walk in our, market will tell you how dire the situation is, particularly when being overweight is culturally associated with good living.

Obesity increases the risk for stroke by several distinct mechanisms including diabetes mellitus, hypertension, accelerated atherosclerosis, atrial fibrillation, and obstructive sleep apnea, all of which independently increase the risk of stroke2. Obesity in this regard serves as the conductor of this orchestra of a disaster waiting to happen.

Other modifiable risk factors responsible for the increase in strokes among young adults include a sedentary lifestyle, poor diet, stress, and its related poor management.

In summary, it is not surprising that the incidence of stroke among young and middle-aged adults is on the increase because all the risk factors are also on the increase. What is surprising, however, is the low level of knowledge in this now at-risk group of adults.

Preventing stroke

Lifestyle changes hold the key to reducing the likelihood of a stroke occurring. For every 10 kg of weight you lose, you can drop both your systolic and diastolic blood pressure by 5-20 points. A drop in your blood pressure will mean a reduction in the pressure within the blood vessels, which means less injury and less risk of blockage. A reduction in weight also improves the functioning of insulin, which would mean less insulin resistance and better blood sugar control. From the above, it is obvious that maintaining an optimum weight is key in mitigating your stroke risk.

Maintain an active lifestyle

• Walking up the stairs instead of using the elevator
• Engage in cardio exercise (jogging, brisk walking, skipping, etc.) at least 3 times a week, each lasting not less than 20 minutes
• Healthy eating; avoid fast foods
• Regular routine checkups at the hospital to ensure early detection of changes.

In conclusion, stroke is not an old people’s disease, it strikes the young.

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The writer, Dr. Kelvin Owusu is a  Medical Director at OptimaCare Diagnostics Ltd.

Contact: +233204317557

Email: [email protected]

References

1. Kissela BMet al 2012 Age at stroke: temporal trends in stroke incidence in a large, biracial population.
2. Walter N. KernanObesity, A Stubbornly Obvious Target for Stroke Prevention
3. Juliet Addo et al, 2006, The Changing Patterns of Hypertension in Ghana: A study of four rural communities in the GA District
4. William K Bosu, 2010, Epidemic of hypertension in Ghana: a systematic review

 

Source: Dr. Kelvin Owusu