Hypertension, Diabetes Mellitus, Obesity, Smoking, and Physical Inactivity as Risk Factors for Stroke in Young Adults: A Systematic Review

Abstract

Stroke in young adults is an emerging global health concern. Incidence is increasing among adults aged 18–45 years. Modifiable cardiovascular risk factors such as hypertension, diabetes mellitus, obesity, smoking, and physical inactivity are believed to play a major role in its development. This study aimed to systematically review and synthesize current evidence on the association between major modifiable risk factors and the occurrence of stroke in young adults. A systematic review was conducted following the PRISMA guidelines. Literature searches were performed in PubMed, Cochrane Library, and Google Scholar for observational studies published between 2021 and 2026. Studies evaluating the association between modifiable cardiovascular risk factors and stroke among adults aged 18-45 years were included. Data were extracted and qualitatively synthesized. Risk of bias was assessed using the NOS and JBI. A total of 13 studies were included. Hypertension was the most consistent and significant risk factor for stroke, followed by diabetes mellitus, smoking, and obesity. Physical inactivity was also associated with stroke in several studies. While most large cohort studies reported significant associations, some smaller studies showed inconsistent findings. Hypertension, diabetes mellitus, obesity, smoking, and physical inactivity remain the primary contributors to stroke in young adults. Early detection and preventive strategies focusing on modifiable risk factors are essential to reduce the growing burden of stroke in this population.