When it comes to killers, stroke is No. 5 in the United States. Stroke is also a leading cause of long-term disability. And both stroke and heart attack are increasingly striking at younger ages — particularly for those who have had obesity or been overweight for a decade or more, though weight doesn’t increase the risk for women over 50 and men older than 65.

That’s according to a study that was just presented at the Endocrine Society’s annual meeting.

“It is well established that people who have excess weight at any point in time have a greater risk of heart attacks and strokes. What was not known was whether it matters for how long someone has been exposed to excess weight,” Dr. Alexander Turchin, director of quality at the Division of Endocrinology at Brigham & Women’s Hospital and associate professor of medicine at Harvard Medical School in Boston, said in a release published by the society.

Researchers at Harvard, Brigham & Women’s Hospital and Eli Lilly analyzed data from the Nurses’ Health Study and Health Professionals Follow-up Study, focusing on patients who had a body mass index above 25 for a decade or more, to assess heart attack and stroke risk over 20 years. In all, they looked at data from 109,259 women and 27,239 men, average age 48.6 and average BMI of 27.2 in the 1990s. They found that 6,862 had atherosclerotic cardiovascular disease, 2,587 had Type 2 diabetes and 65,101 had a history of smoking. At follow-up in 2020, there had been 12,048 cardiovascular events.

“We found that among women younger than 50 and men younger than 65, having obesity over a decade was associated with a 25-60% increase in the risk of heart attack and stroke — and was more important than their weight at a single point in time in 1990,” Turchin said in the release.

The researchers said the findings show that health care professionals who see younger adults living with obesity should direct them into treatment quickly to prevent potentially severe complications later.

Danger in middle age group

The researchers broke the findings down by age. As Dr. Nicole Weinberg, a cardiologist at California’s Providence Saint John’s Health Center in Santa Monica, told Medical News Today, “The middle group had the highest risk. The younger group had less of a disease burden because of the shorter duration of obesity. The older group saw some protective benefits of extra weight. The middle group drives home how a higher BMI can negatively impact health.” She was not involved in the study.

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Medical News Today also interviewed Dr. Sean Heffron, a cardiologist at NYU Langone Health in New York, who is an expert on how obesity impacts heart health. He, too, had no part in the study, though he said he’s looking at some of the same issues. He noted a number of conditions to which obesity contributes:

  • High blood pressure, he said, is a case where severity of obesity has greater impact than duration.
  • Type 2 diabetes, where the opposite is true: Duration of obesity matters more than severity.
  • Abnormal levels of lipids in the blood, where obesity severity is more influential than duration.
  • Various cardiovascular conditions, including cardiomyopathy, where both matter greatly.

About stroke

The American Heart Association notes that most strokes — which are brain bleeds — are caused by high blood pressure, high cholesterol, Type 2 diabetes, obesity, smoking, lack of exercise, alcohol abuse or heart disease (for which those other factors are also risk factors). But strokes are also increasingly occurring in young adults without those risk factors.

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A study published in March in the association’s journal Circulation: Cardiovascular Quality and Outcomes, found that adults younger than 35 to 45 might be at risk because of nontraditional risk factors. The researchers, from University of Colorado School of Medicine, found that migraine is the most important nontraditional risk factor for those ages 18-34 who have a stroke, explaining 20% of strokes in men that age and more than a third of strokes in women.

In a news release, the association wrote that “the analysis found that nontraditional stroke risk factors such as migraines, blood clotting disorders, kidney failure, autoimmune diseases or malignancy, were significantly associated with the development of strokes in men and women 18- to 44-years old. The association between stroke and nontraditional stroke risk factors was stronger in adults younger than 35 years old.”

The Centers for Disease Control and Prevention has reported that stroke prevalence was highest among those age 65 and older and lowest among those ages 18-44, based on 2020-2022 data. But it has been increasing among younger adults. “From 2011–2013 to 2020–2022, stroke prevalence increased 14.6% among adults aged 18–44 years, 15.7% among those aged 45–64 years, 9.3% among women, and 6.2% among men. Among Black, white and Hispanic adults, stroke prevalence increased by 7.8%, 7.2%, and 16.1%, respectively. The largest percent increase (18.2%) occurred among adults with less than a high school education,” per the public health agency.

Get help FAST

The article notes what the CDC calls Act FAST questions to identify stroke and get help quickly:

  • Face: Does one side of the face droop when smiling?
  • Arms: Does one arm drift downward when both arms are raised?
  • Speech: Is speech slurred or strange when repeating a simple phrase?
  • Time: If you see any of these signs, call 911 right away.
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