Experts warn poor lifestyle driving stroke epidemic among youths

Non-communicable diseases are often regarded as conditions of older age, and stroke is one of the most common examples.

However, clinicians say this long-standing perception is rapidly changing, as increasingly alarming cases are being recorded among younger populations, particularly in Nigeria.

The World Health Organisation describes stroke as a medical emergency that occurs when blood flow to the brain is interrupted, either by a blockage or by bleeding.

This interruption, it explains, leads to oxygen deprivation, resulting in brain cell death and potentially severe neurological impairment.

Medically, stroke is classified into ischaemic stroke, caused by obstruction of a cerebral blood vessel by a clot; haemorrhagic stroke, resulting from rupture of a blood vessel with bleeding into brain tissue; and transient ischaemic attack (TIA), a temporary reduction in blood flow to the brain producing stroke-like symptoms that usually resolve within minutes without permanent damage.

Once predominantly associated with older adults, stroke is now increasingly being diagnosed in people in their 20s, 30s, and 40s, a trend neurologists describe as a worrying epidemiological shift.

A 2025 WHO report identified stroke as the second leading cause of death and the third leading cause of disability globally, estimating that one in four adults over the age of 25 will experience a stroke in their lifetime.

Globally, 11.9 million new stroke cases were recorded in 2021, with about 93.8 million people living with the aftermath of stroke-related disability.

Findings from the multinational Stroke Investigative Research and Education Network and other studies indicate that up to 25 per cent of stroke cases in West Africa now occur in individuals under 50.

In Nigeria, stroke remains a leading cause of death and long-term disability, with reported case fatality rates ranging between 22 and 46 per cent within weeks of onset.

As of late 2025 into 2026, the WHO, in collaboration with Nigerian health authorities, continues to classify stroke as a major public health burden, driven by rising incidence in younger adults and persistently high mortality rates.

In a study titled Epidemiology of Young Stroke in Africa, authors Yousufuddin and Young identified age as a key non-modifiable risk factor, noting that stroke risk approximately doubles every 10 years after age 50.

The study also highlighted sex-specific risk factors, including hormonal influences such as oestrogen exposure, oral contraceptive use, and hormone replacement therapy, which may contribute to increased vulnerability in women.

It further referenced Reeves et al., suggesting that longer female life expectancy may partly explain higher stroke prevalence among women.

Among younger populations, additional risk factors include illicit drug use, sickle cell disease, and congenital heart abnormalities.

However, the National Institutes of Health and the National Library of Medicine warn that Nigeria faces increasing pressure on its healthcare system due to the growing burden of stroke and other cardiovascular diseases linked to epidemiological transition.

They estimate a stroke prevalence of 1.14 per 1,000 people in Nigeria, with a 30-day case fatality rate reaching up to 40 per cent.

Another 2025 systematic review titled Prevalence, Characteristics and Treatment Outcomes of Strokes in Nigeria, which analysed 27 studies involving 27,061 participants, found prevalence rates ranging from 0.36 per cent in Sokoto to 13.31 per 1,000 in the Niger Delta.

Hypertension was identified as the leading risk factor, accounting for 80 to 90 per cent of cases.

Ischaemic stroke was more common, representing 59 to 64 per cent of cases, compared with haemorrhagic stroke at 36 to 41 per cent.

Physicians say a growing proportion of strokes among young Nigerians is being driven by modifiable lifestyle factors, undiagnosed medical conditions, and environmental stressors.

Medical experts emphasise the need for early cardiovascular screening and risk factor identification, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, psychological stress, physical inactivity, and excessive intake of alcohol and ultra-processed foods.

They warn that many of these risk factors are “silent,” progressing without symptoms until an acute cerebrovascular event occurs.

A Consultant Neurologist, Dr Demola Olaniyi, told PUNCH Healthwise that the rising incidence is being fuelled by unhealthy lifestyles, untreated chronic diseases, and delayed emergency response.

He noted that stroke is no longer a disease confined to the elderly, as increasing numbers of young adults are now affected.

More concerning, he said, is the tendency among young people to ignore early neurological warning signs such as persistent headache, dizziness, or unilateral numbness, often attributing them to fatigue or non-medical causes, thereby delaying critical intervention.

Reacting to the trend, the Director of the Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Prof Mayowa Owolabi, said stroke and other cardiovascular diseases have overtaken infectious diseases as leading causes of death in Africa.

He identified hypertension, diabetes mellitus, obesity, dyslipidaemia, physical inactivity, tobacco use, and poor dietary patterns, particularly low intake of green leafy vegetables, as key drivers of the rising burden among young people.

According to him, dietary intake of vegetables has a protective effect, while regular physical activity, avoidance of alcohol and fast foods, and early detection of metabolic conditions are critical preventive strategies.

He added that urbanisation-related stressors such as prolonged working hours, poor sleep quality, traffic congestion, and chronic psychosocial stress further compound risk.

“Most risk factors remain asymptomatic until a catastrophic stroke occurs. This makes population-wide screening and long-term risk factor control essential,” Owolabi said.

He explained that neurological symptoms such as facial asymmetry, speech difficulty, limb weakness, visual disturbances, or transient loss of vision, even when brief, require immediate medical evaluation as they may indicate a transient ischaemic attack or impending stroke.

He recalled managing an 18-year-old patient with stroke secondary to previously undiagnosed hypertension, underscoring that cerebrovascular disease is no longer restricted to older adults.

Findings from the SIREN study, he noted, showed that the leading cause of stroke, even among individuals under 50, remains undiagnosed, untreated, or poorly controlled hypertension, followed by hypercholesterolaemia, which is often clinically silent.

He stressed the need for routine screening of blood pressure, blood glucose, and lipid profiles at least twice yearly.

The expert cited other major contributors to include diabetes mellitus, central obesity (abdominal or “visceral” obesity), and cigarette smoking.

Owolabi advised that suspected stroke cases should be promptly taken to facilities with dedicated stroke units to improve survival and reduce complications.

He added that management requires multidisciplinary care to prevent complications such as aspiration pneumonia, infections, and thromboembolism, alongside strict control of blood pressure and glucose levels.

Owolabi concluded that stroke care revolves around three key objectives: survival, prevention of recurrence, and functional recovery through coordinated rehabilitation involving physiotherapy, speech therapy, psychological support, and other multidisciplinary interventions.