Heart health is improving overall. So why are strokes rising among young adults?
By some measures, young adults in the U.S. are healthier — or at least more health-conscious, judging by their spending on wellness goods and services, as well as social media posts — than previous generations. And yet, according to a new American Heart Association (AHA) report, something worrying is going on with the cardiovascular health of young Americans: In 2023, rates of deaths from heart disease finally fell back to pre-COVID levels for U.S. adults, but the number of 25- to 34-year-olds dying of strokes continued to climb. The report also showed that obesity rates leveled off for adults — but kept rising among children.
The report raises more questions than it provides answers. What is happening to young adults, and why is their cardiovascular health getting worse while it’s improving for the broader population? And if rates of obesity are falling among adults, why isn’t that happening among children? Three charts tell the story of young Americans’ cardiovascular health, and two experts provide insights into the challenges the group might uniquely face.
Cardiovascular deaths are declining — but major risk factors remain
Cardiovascular disease — which includes stroke, high blood pressure, heart disease and heart failure — is the leading cause of death among adults in the U.S. In 2023 alone, it claimed the lives of 915,973 people, per the AHA report. That means one in four people that year died from heart disease or stroke.
Yet that’s a considerable improvement from 2022, when 25,679 more people died from these conditions. Much of the decline in cardiovascular deaths can be attributed to the end of the COVID-19 pandemic emergency, Dr. Latha Palaniappan, associate dean for research at Stanford University School of Medicine and volunteer chair of the committee that assembled the AHA’s latest report, tells Yahoo. During the early stages of the pandemic, many doctors’ appointments were canceled, postponed or moved to telehealth to reduce the spread of the virus and alleviate the overburdened health care system, while some people avoided in-person care altogether out of fear of COVID-19 exposure. It took a couple of years before people started going back to their doctors as routinely as they had pre-pandemic. That return helped doctors address health issues, diagnose problems and adjust medications, which resulted in fewer cardiovascular disease deaths.
However, “we have not seen — in terms of obesity trends, for instance — that there has been an extreme improvement in risk factors,” says Palaniappan. Half of all adults still have high blood pressure, and many, especially younger adults, don’t realize it. Obesity rates are still high, even though the rise in recent years leveled off in 2023. And there may be unique issues facing younger generations.
Stroke deaths continue to rise for young Americans
After climbing during the pandemic, the rate of stroke deaths among all adults in the United States declined from 39.5 per 100,000 in 2022 to 39.0 per 100,000 in 2023. However, stroke death rates were still 7.7% higher in 2023 than they were a decade prior. Among adults ages 25 to 34, the increase has been even steeper, with stroke death rates up 8.3% since 2013. Even though the total number of stroke deaths in the age group is relatively low (1.3 for every 100,000), “strokes in young adults are very alarming,” Dr. Bradley Serwer, an interventional cardiologist and chief medical officer at VitalSolution in Maryland, tells Yahoo. “But it’s hard to parse out reasons,” he adds.
It will take more research to definitively say what’s driving these cardiovascular problems among young adults, but Serwer and Palaniappan have some theories.
- Young adults are developing serious cardiovascular risk factors earlier. Those include high blood pressure, obesity and diabetes. “Many young adults don’t know they have these risk factors, and they aren’t being treated,” Palaniappan says.
- A rise in kidney disease is driving up heart disease risks too. As more people develop obesity, high blood pressure and diabetes earlier in life, rates of chronic kidney problems are rising. Kidney disease can raise the risk of heart disease (and vice versa), and both conditions share many of the same risk factors. The AHA has been highlighting the heart-kidney connection to improve prevention of these conditions, especially since kidney disease is much easier to screen for with a urine test than heart disease, note Serwer and Palaniappan.
- Smoking rates are down, but more adolescents and young adults are picking up e-cigarettes. And recent research suggests that vaping may be even worse for heart health than cigarette smoking. E-cigarettes’ nicotine “tends to be more concentrated, and the effects can be more severe [than smoking] on the cardiovascular system,” says Palanniapan. It’s hard to say to what extent e-cigarettes are influencing heart disease and stroke trends in younger and older adults, Serwer emphasizes. But, “we didn’t have vapes when I was growing up in the ’80s and ’90s …. they have a lot of negative health effects that we didn’t have when my generation grew up,” he says.
- Young adults are all or nothing with physical activity. Serwer has noticed “a more pronounced dichotomy in activity levels” among today’s young adults than in the past. “Social media presence, screen time and sedentary lifestyles have gone up,” and physical inactivity is a known risk factor for cardiovascular disease, he says. At the same, social media has also prompted a “push for people trying to look good [and get] aggressive with exercise,” including taking pre-workout supplements. Many of these supplements contain high concentrations of caffeine or other stimulants that can raise blood pressure and damage blood vessels. The same goes for highly caffeinated energy drinks, which, like supplements, have already led to heart attacks and strokes in otherwise healthy, fit, young people. Experts note it’s hard to say how big a factor caffeinated supplements and drinks are with strokes in young adults, but they’re concerning to Serwer.
- Today’s young adults have been consuming more ultraprocessed foods — such as chips, candy, deli meat and the occasional burger — and sugary beverages for longer than older generations. It’s OK to have some of these foods in your diet, but eating too many ultraprocessed meals and snacks can harm your health, and most people eat way too many. In fact, more than half of the calories consumed in an average American’s diet come from ultraprocessed foods, according to the AHA. As with vaping, today’s kids are growing up surrounded by far more ultraprocessed foods than previous generations. And the earlier people start eating lots of nutrient-poor meals, snacks and sugary drinks, the greater the impact on their weight, kidney and heart health. That’s why Serwer and Palaniappan are especially worried for children and adolescents. (More on that later.)
The steep rise in obesity has slowed for adults — but not for kids
It’s a very small improvement, but a step in the right direction nonetheless: 50% of U.S. adults had obesity during 2021-23, compared with 51.1% between 2017 and 2020, per the new AHA report. Childhood obesity rates, however, increased over the same period, rising nearly 3 percentage points to 28.1%.
“The rates are increasing because we have, for instance, higher rates of obesity than we’ve ever had in young populations,” says Palaniappan. “The lifetime accumulation of these risks is leading to higher [negative] cardiovascular outcomes.”
Adds Serwer: ”We have to sit back and wonder, what are we doing differently as a society and a medical community now [compared with 25 years ago] that’s allowed this to occur? And the answers aren’t simple,” he says. Palaniappan, however, has some ideas. “If we want childhood obesity rates to improve, we have to change the default to healthier school meals, more physical activity during the schoolday, better sleep and less exposure to ultraprocessed foods and sugary drinks,” she says. Ultraprocessed foods typically have very high concentrations of sugar, salt and saturated fats. Too much of these nutrients can wreak havoc on cardiovascular health by raising blood pressure and cholesterol and contributing to the hardening of arteries. Plus, these ingredients make foods more pleasurable to consume, less filling and less nutritious — an “obesogenic” combination.
The earlier kids get in the habit of eating more whole foods and fewer processed ones, while spending more time active than sedentary, the better. These same practices also help reduce the risks of heart disease and stroke at any age. The AHA calls them “Life’s Essential 8”: Eat better, be more active, quit tobacco, get healthy sleep, manage weight, control cholesterol, manage blood sugar and manage blood pressure. The good news is that “80% of cardiovascular disease outcomes are preventable with lifestyle changes,” says Palaniappan.
