A growing proportion of strokes now occur in people in mid-life. Photo / 123RF
A growing number of people in midlife now suffer from strokes. Here’s what you can do to lessen your chances of having on.
It had been a perfect start to 2022. Alexa Connolly, a language teacher from London, was on holiday in Spain with her husband and two adult sons. The family celebrated with dinner in a Marbella restaurant, before seeing in the New Year.
After her late night, Alexa spent the next day relaxing, when, suddenly, at 5pm, she found herself paralysed in her chair.
“I felt as if I couldn’t get up and struggled to shout out for help,” she recalls.
Luckily, her eldest son heard her attempts, and alerted Alexa’s husband. They realised that she was having a massive stroke and called an ambulance. By the time Alexa reached a specialist unit in Malaga, she had lost all movement in the left-hand side of her body.
A stroke is sometimes described as a ‘brain attack’. They usually happen when the blood supply to part of the brain is cut off, killing brain cells. A rarer type of stroke involves bleeding in the brain, though the effect on cells is similar.
It is serious and life-threatening, and mostly affects elderly people. “Around 100,000 people have a stroke every year, that’s one every five minutes,” says Dr Clare Jonas of the charity the Stroke Association.
However, Alexa did not fit this mould. She was just 64, slim, didn’t drink alcohol or smoke and kept fit with a personal trainer twice a week. “I had no warning and never expected it to happen to me,” she says.
A growing proportion of strokes now occur in people in mid-life – many of them even younger than Alexa. Overall, a quarter of strokes happen to those under 65, and in 2018, Public Health England reported an even larger proportion – 38 per cent – of first-time strokes occurring in people aged 40 to 69.
So why is this rise happening? Dr Jonas says that half of strokes in people under 50 “have no obvious cause”, however it is likely that unhealthy lifestyles are fuelling the increase. High blood pressure is the single biggest risk-factor for stroke, and while anyone can develop high blood pressure, smoking, drinking, obesity and sedentary habits all increase the risk. “If it is not identified in time for people to have preventative treatment,” says Dr Jonas, “a stroke can come out of the blue.”
Yet a 2020 study published in the British Medical Journal found that almost half of people with high blood pressure (47 per cent) were unaware of their condition and more than a quarter of those who were aware (27 per cent) weren’t taking any drugs to treat it.
Despite Alexa’s healthy way of life, it turned out that she too was living with a ticking time-bomb in the form of dangerously high blood pressure. When she arrived at hospital her blood pressure was 230/200 – healthy blood pressure should be 120/80 or less.
Previous tests over the years had shown elevated readings, but she says, because she suffered from anxiety, doctors assumed this was due to ‘white coat syndrome’ – a stress response to a medical environment. Ironically, a new doctor had finally flagged up her “far too high” blood pressure a couple of months previously, and she had an appointment for treatment in January – which turned out to be too late.
Mid-life stroke can have devastating effects on people who might expect to be in their prime. As well as being the UK’s fourth biggest killer, stroke causes an epidemic of disability. According to the Stroke Association, a third of stroke survivors have to give up work entirely and a further 15 per cent have to reduce their hours.
Nine out of 10 survivors live with at least one cognitive effect of stroke, such as problems with memory or concentration. A third have difficulty speaking or understanding language and almost half develop depression.
“Stroke is the primary cause of complex adult disability in the UK,” says Dr Jonas. However, experts say that with better screening and treatment, plus lifestyle changes, many of these strokes could be prevented.
Cardiologist Chris Gale, professor of Cardiovascular Medicine at the University of Leeds, is campaigning to raise awareness of another fast-growing ‘hidden’ stroke risk. Atrial fibrillation (AF) is a dangerous heart rhythm condition and a major cause of stroke. Gale’s research has found that it has increased by a staggering 70 per cent in England over the last two decades.
High blood pressure raises the risk of this irregular heart rhythm – by 72 per cent and it is, he says, “the main direct cause of stroke in young people”. Yet most of us have never heard of it.
According to the British Heart Foundation, which funded Gale’s research, “AF happens when the electrical impulses in the top chambers of the heart fire chaotically, when they should be steady and regular, causing them to quiver or twitch. This can cause blood to pool in these chambers which increases the risk of clots and life-threatening strokes. People with AF are five times more likely to have a stroke, and the stroke is more likely to be debilitating with a lower chance of surviving.”
Gale says: “New cases of AF in the UK now outnumber the diagnoses of the four most common cancers in UK. What’s more, around one in five of the 1.2 million people with diagnosed atrial fibrillation are under 65.” Even more worryingly, he says, “that around of third of people with atrial fibrillation – 300,000 – are undiagnosed and untreated, leading to 15,000 preventable strokes a year.”
Symptoms of AF include breathlessness on exertion and palpitations, or an erratic racing heart, but 30 per cent of people with AF are asymptomatic.
Professor Gale and his team have developed a new digital prediction tool for AF that aims to detect it early, which they hope can soon be trialled in the NHS.
In the meantime, he says, people can check their own pulse to see if the beat is regular, or use the Heart Rate app on a smart watch to alert them to irregular heart rhythms. If you are diagnosed with AF you may be given blood thinners to reduce your risk of stroke. Plus, this is a chance to add in any medications that may be needed to lower blood pressure or treat diabetes. Professor Gale believes that current pharma therapies reduce risk of stroke by about two thirds.
After a hospital scan revealed a clot in Alexa’s brain, she was given a clot buster drug less than three hours later. She credits prompt treatment for helping her regain “99 per cent of my motor skills.” She also learned that, like one in four people, she had a tiny hole in her heart which allowed the clot to travel to the brain, and had an operation to close the hole to help prevent a further stroke.
In terms of treatment, Alexa is taking aspirin to thin her blood, statins and blood pressure reduction drugs. She now campaigns for stroke awareness with the charity Style For Stroke. “Everyone should take high blood pressure very seriously,” she says. “People should also understand the symptoms of stroke, as it can happen without warning and speed is essential. I wish I had been diagnosed sooner.”
Monitor your blood pressure
Healthy blood pressure is between 90/60 and 120/80. High blood pressure is considered anything over 140/90. Have your blood pressure measured at your local pharmacy or buy a device online to monitor it at home.
Lead a healthy lifestyle as possible
Cut down on alcohol, stop smoking and maintain a healthy weight. A 2015 study of adults under 50 found that obesity raised the risk of stroke by 73 per cent in men and 46 per cent in women, compared to people with a normal BMI.
Aim for 150 minutes of moderate exercise a week
Lack of physical activity can lead to higher triglycerides, higher cholesterol levels, and an increased risk of stroke.
Make sure you take any prescribed medications for conditions such as diabetes or high cholesterol
People with diabetes are more than twice as likely to have a stroke as people without.
Accept screening tests and talk to your doctor if you have a family history of strokes
Some strokes are linked to genetic conditions such as haemochromatosis – which causes iron to build up in the blood, or hypercholesterolemia, which leads to high cholesterol levels.
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