Rutgers’ Stroke Study Shows Younger Adults Face Growing Risk

Researchers find rate is dropping among New Jerseyans over 55, but indicate potentially alarming news for those 35 to 44

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While older people remain more likely to suffer from a stroke, the rate at which these potentially debilitating incidents impact individuals over age 55 has declined, according to an analysis of two decades worth of healthcare data that may be the first of its kind on this scale.

But the news for those aged 35 to 44 was more alarming, as the stroke rate doubled or more for this cohort over the same time period, revealed the study by a group of Rutgers University researchers who tracked more than 200,000 New Jersey patients from 1995 through 2014. Highlights of their work were published last week in the Journal of the American Heart Association.

While the study didn’t directly examine causes, researchers said it could enable physicians to help patients of all ages avoid a stroke, which can result in permanent brain damage or death. It also raises additional questions about the impact early lifestyle choices can have on long-term health, they added, an approach that dovetails with a growing interest in population health. Some eight in 10 strokes are preventable, according to the American Stroke Association.

While medical advances have significantly decreased stroke rates and related deaths, the Rutgers team said the growing incidence of diabetes, obesity, and other cardiovascular risk factors are putting younger generations in harm’s way. Older cohorts have shown lower rates of these chronic conditions, which can stress the circulatory system and trigger a stroke, in which blood flow to the brain is interrupted.

Despite the improvements, stroke remains a
leading cause of death in New Jersey — killing nearly 1,000 people annually and landing more than 20,000 in the hospital.

“People, especially those under 50, need to realize that stroke does not just occur in the old, and the outcome can be much more debilitating than a heart attack — leaving you living for another 30 to 50 years with a physical disability,” said Joel N. Swerdel, a lead author and a doctoral candidate at Rutgers School of Public Health. The data helps cardiologists explain to at-risk patients, especially younger ones, the “need for significant behavioral changes,” Swerdel added.

The study, which will continue as new data is collected, is the first analysis of this size and scope to examine patients over several decades, but its findings echo the results of similar efforts in Europe and individual communities in America. The Rutgers team collected information on almost all hospital admissions for heart disease and myocardial infarction or stroke dating back to 1995, as well as death certificates and other state information, and constructed a massive database. Each record was assigned an ID number, to protect personal identities.

“We have, literally, everybody; every admission for cardio (related incidents), and every follow-up” at a hospital, explained Dr. John B. Kostis, a co-author and cardiologist who teaches at the Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, in New Brunswick. Other authors included Dr. George G. Rhoades; Jerry Q. Cheng; Nora M. Cosgrove, R.N.; and Dr. Abel E. Moreyra. The study was funded by the Robert Wood Johnson Foundation and the Schering-Plough Foundation.

Reviewing this massive data set, with a diverse set of patients that evolved over time, gave researchers a unique ability to track how stroke rates changed as each cohort aged. When comparing these age groups, researchers found those born between 1945 and 1954 had lower rates of stroke than those born two decades earlier or later.

While it’s not clear why these older Baby Boomers have an advantage, this group has lower rates of diabetes, obesity, and smoking — and may be more likely to follow their doctors’ advice when it comes to taking preventative drugs for high blood pressure and other risk factors, the researchers suggested.

“No matter what the cause, being aware of the risk in younger generations is important to encourage people to take their prescribed medications and strongly consider lifestyle changes, including exercise and a better diet,” Swerdel said.

The findings also underscore the need for more study of how food, exercise, and other lifestyle choices influence heart health, especially over time. And with growing opportunities to collect new data through wristwatch heart monitors and other devices much more can be learned, the researchers said.

“The whole idea is to look at the patient in total, to know as much as possible about the patient,” Kostis explained. “Then we can look at the associations,” he added. “That’s where cardiovascular health is going.”