It's better to treat: strokes and heart attacks are not only found in the elderly
Doctors are sounding the alarm: strokes and heart attacks have become younger. According to WHO, over the past two decades, the proportion of vascular accidents among those who have not yet crossed the half-century mark has almost doubled. Why statistics are changing so much, why such serious health problems overtake the young and whether they are genetically predetermined — in the material of Izvestia.
Why do statistics change?
Natalia Koryavtseva, a neurologist, medical expert at the ORBI Stroke Foundation, and a member of the All-Russian Society of Neurology, emphasizes that in the last 10-15 years, vascular catastrophes among young people have really become more noticeable for the healthcare system. Experts attribute this not only to the characteristic risk factors — obesity, hypertension, impaired carbohydrate metabolism, smoking and low physical activity. There is another significant reason — the diagnosis has improved.
Vascular centers have appeared, CT and MRI scans, CT angiography, and neuroimaging are more widely used in the first hours of illness. Therefore, some cases that previously could have remained unrecognized or received a different diagnosis are now correctly registered as a stroke," the neurologist comments.
According to international data, the proportion of acute cerebral circulatory disorders in people under 50 years of age is about 10-15% of all cases, the expert emphasizes. According to various estimates, the incidence of ischemic stroke in the 18-49 age group in different countries has increased by about 20-40% in recent decades, especially due to the 35-49 age group.
— The situation is similar for myocardial infarction: the vast majority of cases still occur in old age. But in the registers of different countries, the proportion of patients under 45 years of age among all cases of heart attack is usually about 5-10%, and in people under 55 years of age, an unfavorable trend persists in a number of cases, especially in the presence of obesity, diabetes, smoking and hypertension," comments the editorial interlocutor.
As for Russian practice, doctors also note that patients aged 35-45 are no longer uncommon in vascular departments.
— It is this age group that is currently causing the most concern: by the age of 35-45, a person may already have accumulated risk factors, but he does not consider himself ill, complains Natalia Koryavtseva. — He may not measure blood pressure for years, not know cholesterol and glucose levels, not treat sleep disorders, ignore excess weight and smoking.
Fortunately, strokes and heart attacks are less common in people aged 25-35, and if they do occur, they are most often associated not only with classical atherosclerosis, the expert emphasizes.
"The causes may be blood clotting disorders, congenital or acquired heart diseases, rhythm disorders, inflammatory and autoimmune diseases, arterial dissection, migraine with aura in combination with other risk factors, smoking, including electronic cigarettes, taking certain medications and psychoactive substances," the neurologist lists.
Why smokers are at risk
Natalia Koryavtseva considers the main problem to be the fact that vascular catastrophe is often not recognized in time. Both the patient and his family may attribute the symptoms to overwork, panic attack, neck problems, lack of sleep, or "something temporary." In cases of stroke and heart attack, such a delay is dangerous, because effective care is most effective in the first hours.
— Arterial hypertension remains one of the main risk factors for stroke. It is often undiagnosed in young people: a person can live with a pressure of 140/90 mmHg or higher, consider headaches or palpitations to be a reaction to stress and not consult a doctor. At the same time, the vascular wall is constantly under increased stress," explains the editorial interlocutor.
All doctors unanimously consider smoking to be the main cause of vascular disasters. Smokers are especially vulnerable when it comes to strokes.
"E—cigarettes cannot be considered a safe alternative to regular smoking,— the neurologist warns. — Nicotine in any case causes vasospasm, increases blood pressure and heart rate; impairs the function of the endothelium, that is, the inner lining of blood vessels; may increase the tendency to thrombosis.
It is especially dangerous if smoking is "layered" with hypertension, obesity, migraine with aura, taking estrogen-containing drugs, and a hereditary tendency to thrombosis.
"Energy companies that are popular with young people are also not harmless," the expert continues. — High doses of caffeine and other stimulants can cause heart palpitations, high blood pressure, anxiety, sleep disorders, and in predisposed people, heart rhythm disorders. The risk increases if energy drinks are consumed against a background of lack of sleep, intense exercise, alcohol, smoking, or pre-existing heart disease.
The doctor pays special attention to dissomnia (sleep disorders), as well as obstructive sleep apnea syndrome (OSA), in which breathing stops during night rest, oxygen levels drop, sudden pressure fluctuations occur, and the cardiovascular system is activated.
— This is associated with an increased risk of hypertension, rhythm disturbances, stroke and heart attack. Young age does not exclude OSA, especially with excess weight, snoring, daytime sleepiness, morning headaches and high blood pressure, the neurologist warns.
According to her, sleep disorders and circadian rhythms physiologically affect the cardiovascular system. Regular sleep of less than six hours, night shifts, sudden shifts in sleep patterns, frequent nighttime awakenings, and chronic insomnia are associated with an increased risk of hypertension, obesity, insulin resistance, cardiac arrhythmias, and vascular problems.
— It is important not to miss obstructive sleep apnea syndrome. A person sometimes thinks that he is just "not sleeping well" or "not getting enough sleep," but in fact, every night he has episodes of respiratory arrest. The body responds with releases of adrenergic mediators, pressure rises, and fluctuations in oxygen in the blood. Over time, this increases the load on the heart and blood vessels," says Natalia Koryavtseva.
She also draws attention to a rather rare but important cause of stroke in young people — dissection, that is, dissection of the carotid or vertebral artery wall.
— It can occur after neck injury, sudden movements, sometimes after intense external effects on the cervical region. Therefore, it is necessary to urgently seek medical help in case of sudden severe pain in the neck or head, especially if speech, vision, coordination, weakness or numbness appear later, the neurologist warns.
Is there a genetic predisposition to stroke
Alexander Rakitko, Director of Science at the Genotek genetic laboratory, Candidate of Physico-mathematical Sciences, notes that genetics also affects the risk of heart attack and stroke, but in most cases it is not about one "disease gene", but about a combination of hundreds and thousands of genetic variants.
"These diseases are considered multifactorial: a hereditary predisposition is realized together with factors such as age, cholesterol levels, blood pressure and lifestyle," he comments. — The contribution of genetics to the risk of ischemic stroke is estimated at about 15-40%, and for coronary heart disease — about 40-60%.
The source gives examples of genes that play a particularly important role when it comes to vascular disasters.
— For example, LDLR is responsible for removing "bad" cholesterol from the blood. If a pathogenic mutation occurs in this gene, the level of low-density lipoproteins (LDL. — Izvestia) remains elevated from an early age, which accelerates the development of atherosclerosis and significantly increases the risk of early heart attack and stroke. A similar effect can be caused by rare mutations in the APOB gene," explains the candidate of physico—mathematical sciences.
However, the analysis of these genes alone is not enough to assess the risk in a particular person, the specialist warns. According to him, modern DNA tests use polygenic risk scales that take into account the cumulative effect of thousands of genetic variants. They make it possible to identify people with the highest hereditary risk, who may be several times more likely to develop coronary heart disease than the population average.
— It is especially important for such people to control their cholesterol and blood pressure levels, stop smoking, maintain a normal body weight and undergo regular preventive examinations. A personalized approach to prevention can significantly reduce the risk of cardiovascular diseases, delay their development or prevent their occurrence altogether," comments Alexander Rakitko.
Natalia Koryavtseva agrees that vascular catastrophes in some young patients are indeed related to hereditary or non-obvious factors. However, she does not recommend mass delivery of "genetic panels for everything" without indications — it is much more important to know family history and basic health indicators.
According to the neurologist, one of the key hereditary factors of early atherosclerosis is hereditary hypercholesterolemia. It can be suspected if a person has very high levels of LDL cholesterol from a young age, especially with early heart attacks or strokes in relatives. Genetically, this may be due to variants in the LDLR, APOB, PCSK9, and some other genes, but in practice, high LDL itself and family history require the attention of a doctor.
What you need to know in order not to miss the disease
For most people, prevention begins with simple and affordable things, Natalia Koryavtseva emphasizes. After the age of 25-30, it is important to regularly measure blood pressure, know your weight, waist circumference, cholesterol and glucose levels.
— The minimum preventive kit includes blood pressure measurement, a lipid profile with LDL, HDL and triglycerides, blood glucose or glycated hemoglobin, a general blood test, creatinine with an assessment of kidney function, a general urinalysis for suspected hypertension or kidney disease, an ECG for palpitations, seizures, fainting, chest pain or high blood pressure- says the doctor.
According to her, it is advisable to measure the level of lipoprotein (or Lp) at least once in a lifetime, especially with a family history of early heart attacks, strokes or sudden death.
— If you have snoring, daytime sleepiness, obesity, morning headaches, high blood pressure or a bad effect from hypertension treatment, you need to be examined for obstructive sleep apnea syndrome. This can be night pulse oximetry, cardiorespiratory monitoring, or polysomnography as prescribed by a doctor," the neurologist continues.
If relatives have had heart attacks, strokes, or sudden death in men under 55 and women under 65, it is better to start preventive checkups earlier, from the age of 20-25.
— The doctor may prescribe an extended lipidogram, echocardiography, daily blood pressure monitoring, Holter ECG monitoring, examination for thrombophilia or autoimmune causes. But such studies are not necessary for everyone, but for indications," explains Natalia Koryavtseva.
Physical inactivity, excessive consumption of sugar, fast food, trans fats, salt, and ultra-processed foods increase the risk of obesity, type 2 diabetes, hypertension, and atherosclerosis. In young people, these processes can be asymptomatic for a long time, warns the editorial interlocutor, adding that young age does not protect against stroke and heart attack. If symptoms of a vascular catastrophe appear, one cannot expect that "it will pass by itself."
The doctor recalls the signs of a stroke:
— sudden asymmetry of the face, weakness or numbness of the arm or leg on one side;
— speech disorders, vision problems — double vision or loss of part of the visual field;
— severe instability, impaired coordination, severe headache of an unusual nature.
Even if the symptoms have passed after 5-10 minutes, you should not refuse medical care — it may be a transient ischemic attack. And such a condition is often a warning about the risk of a major stroke in the coming hours or days, warns Natalia Koryavtseva.
Among the signs of a heart attack, the neurologist lists:
— pressure, burning or squeezing behind the sternum, pain with recoil in the left arm, shoulder, neck, jaw, back;
— sudden shortness of breath, cold sweat, severe weakness, nausea, palpitations, fainting or fainting.
— young people and women may also experience atypical symptoms — discomfort instead of severe pain, lack of air, weakness, pain in the upper abdomen or back.
In any case, the algorithm of actions is simple: if a stroke or heart attack is suspected, you should immediately call an ambulance and clearly indicate the time of onset of symptoms. The sooner the patient gets to the vascular center, the higher the chance of survival and recovery.
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