Iron Deficiency Anemia Significantly Increases Ischemic Stroke Risk in Young Adults

Findings from a recent study suggest iron deficiency anemia (IDA) independently and significantly increases the odds of ischemic stroke in young adults.1

IDA is the most common form of anemia globally. It results from iron deficiency, when there are insufficient iron stores to support the production of red blood cells. IDA disproportionately affects women due to regular iron losses through menstruation and increased iron demands during pregnancy. Maternal anemia can lead to the child exhibiting intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder.2

Additionally, it is currently estimated that 10-15% of all strokes occur in adults aged 18-50, a group that also exhibits an increased prevalence of IDA. However, little data has been collected regarding the association between IDA and stroke in young adults.1

“Although multiple studies have explored the association of IDA and thrombotic events in children, our study was the first to explore its role in ischemic stroke in a young adult population, that is, most susceptible to IDA,” wrote Jahnavi Gollamudi, MD, University of Cincinnati, and colleagues.1

Investigators classified patients into 2 groups: those with a first-time ischemic stroke diagnosis were defined as Group A, and those without a history of ischemic stroke were defined as Group B.1

Investigators queried an aggregate of health record data from more than 300 hospitals across the US, collecting information on patients 15-50 years of age with and without a history of ischemic stroke. Patients with known diagnosis of thrombocytosis, malignancy, atrial fibrillation, antiphospholipid syndrome, previous history of stroke, pregnancy, hemoglobinopathies including sickle cell trait, use of combined oral contraceptives, thrombophilia, obesity, and use of anticoagulants 1 year prior to onset of stroke were excluded.1

A total of 21,802,239 patients were initially identified; 36,989 were assigned to Group A and 21,765,250 were assigned to Group B. In Group A, 1880 (5.1%) had a diagnosis of antecedent IDA. In Group B, 241,110 participants had a first-time diagnosis of IDA (1.10%).1

Investigators noted Group A exhibited greater proportions of hypertension, diabetes, dyslipidemia, smoking, and obesity compared to Group B. Those with antecedent IDA exhibited a substantially greater risk of stroke after multivariable analysis. IDA was associated with 39% increased odds of stroke (P <.001) independently of all other described risk factors.1

A significant statistical interaction was detected between IDA, age, and non-Caucasian race on ischemic stroke (P <.05). Based on this association, investigators determined African American adults 20–39 years of age had a greater likelihood of ischemic stroke than Caucasian adults aged 40–50 years with IDA.

Additionally, the team makes note of possible external factors, such as access to a nutritional diet and fewer regular healthcare visits, that could lead to increased atherosclerotic risk factors and IDA.1

Given the size and scope of the database utilized in the study, investigators also indicated that a general concept of IDA prevalence can be estimated. The overall population in the study exhibited a 1.11% prevalence, compared to the previously reported 5%, which the team attributes to underdiagnosis and underreporting of IDA outside of a laboratory setting.1

“In summary, we demonstrate an association between antecedent IDA and ischemic stroke in young adults,” wrote Gollamudi and colleagues. “Given the high prevalence of IDA in this population, an effective screening strategy is urgently needed to diminish its subsequent complications.”1

References

1. Gollamudi J, Al-Kindi S, Nayak L. Iron Deficiency Anemia and Ischemic Stroke in Young Adults. EJHaem. 2025;6(2):e70008. Published 2025 Apr 23. doi:10.1002/jha2.70008

2. Tang GH, Sholzberg M. Iron deficiency anemia among women: An issue of Health Equity. Blood Reviews. 2024;64:101159. doi:10.1016/j.blre.2023.101159