Strokes are projected to account for nearly 10 million deaths annually by 2050. Doctors suggest where we are going wrong and how to prevent strokes.
Published Oct 14, 2023 | 9:00 AM ⚊ Updated Oct 14, 2023 | 9:00 AM
India has been seeing an alarming rise in non-communicable diseases, like stroke, in the recent years. (Creative Commons)
Research has long indicated that stroke is one of the leading causes of death globally. In 2019, India saw a staggering 1.3 million new cases of stroke, topping the charts in the World Health Organisation’s (WHO) Southeast Asia Region.
A recent study highlighted the burden, risk factors, and unique etiologies of stroke in the South-East Asia Region.
The comprehensive study, showcased in The Lancet Regional Health – Southeast Asia, was a collaborative effort between the Indian Council of Medical Research (ICMR) and prominent medical entities in India, Sri Lanka, and Singapore.
“The fact that India recorded around 1.3 million (13 lakh) new stroke cases in 2019 is alarming,” renowned neurologist Dr Sudhir Kumar at Apollo Hospitals, Hyderabad, tells South First.
“This high incidence can be attributed to multiple factors, including lifestyle changes, increased prevalence of risk factors like hypertension, diabetes, and smoking, as well as genetic predispositions in the population,” he explains.
Furthermore, the research emphasised that strokes substantially influence the overall neurological disorder DALYs (disability-adjusted life years) in India, representing nearly 38 percent of the total burden.
It is anticipated that by 2050, global stroke fatalities will escalate to 9.7 million from 6.6 million (in 2020), predominantly affecting low- to middle-income nations. The study pinpointed leading stroke risk factors, including hypertension, diabetes mellitus, elevated cholesterol levels, obesity, poor diet choices, a sedentary way of life, and tobacco use.
A collaborative research effort involving experts from 146 global regions, this analysis was part of the expansive Global Burden of Disease Study 2019. Its primary objective was to present current and extensive data on the frequency, prevalence, mortality rates, and DALYs related to stroke and other neurological conditions.
The US Centers For Disease Control and Prevention (CDC) defines a stroke as an obstruction of blood flow to the brain or when a blood vessel within the brain ruptures. This interruption can lead to lasting damage, persistent disabilities, or even mortality.
The brain is responsible for movement, memory retention, cognition, emotions, language, and other vital bodily functions. A continual supply of oxygen, delivered by the arteries, is essential for its optimal functioning.
Any disruption in this blood supply can starve brain cells of oxygen, causing them to perish within minutes, leading to a stroke.
Strokes can manifest in various ways, depending on their severity. Speaking to South First, Dr NK Venkataramana, Chairman of Brains Super Speciality Hospital in Bengaluru, says that the common signs include:
BEFAST is the commonly used stroke acronym to help the public easily remember the signs of a stroke. (Ohio State Health)
Mobility: Difficulty walking, dizziness, or loss of coordination.
Vision: Sudden vision disturbance in one or both eyes.
Face: A noticeable drop or numbness, especially if one side seems affected.
Physical sensations: Numbness or paralysis often localised to one side of the body, affecting the face, arm, or leg.
Speech: Challenges in speaking or comprehending speech.
Other symptoms include severe and abrupt headaches, nausea, or altered consciousness.
According to Dr Venkataramana, stroke is the leading cause of acquired disability in the world and the third leading cause of death in India.
“Strokes kill more women than breast cancer and one person is stricken by a brain attack every 45 seconds. One in six people have experienced a stroke at least once in their lifetime,” Dr Venkataramana tells South First.
He adds, “The disease burden is such that two million people are affected by stroke every year in India. Among them, 20 to 30 percent are under the age of 45, identified as a distinct entity ‘Stroke in Young Adults’. Managing them has many special challenges.”
Dr Sudhir Kumar explains that while there are some risks that one cannot control, there are several preventive measures and modifiable risk factors that are unfortunately being neglected by people.
He warns that as long as this negligence continues, the increase in stroke risk will also continue to rise exponentially. “The Lancet study’s alarm on the increase of stroke incidence and mortality by 2050 will surely come true if people do not take action TODAY,” he warns.
Citing some of the modifiable factors, Dr Kumar says, “At the forefront is high blood pressure (BP), touted as the most common risk factor for stroke. Alarmingly, many are unaware of their hypertensive status due to its often asymptomatic nature. Unless individuals make an effort to get their BP checked regularly, detection becomes challenging.”
“Moreover, among those diagnosed, many do not take their medications as prescribed, resulting in uncontrolled BP in nearly half of them,” he explains.
Ultra processed food or UPF in a supermarket. (iStock)
Also, dietary habits play a pivotal role in stroke risk, with increased salt intake and consumption of aerated drinks and ultra-processed foods leading the charge. These poor dietary choices, apart from raising one’s BP, also contribute to the rising obesity rates and diabetes prevalence, including prediabetes.
Dr Sudhir Kumar reminds us that these are all significant modifiable risk factors.
Meanwhile, lifestyle habits such as smoking, excessive alcohol consumption, and insufficient sleep also elevate stroke risk. Notably, routine alcohol usage can lead to both ischemic stroke and brain haemorrhage.
On the flip side, there are non-modifiable factors that we must take into account. As medical advancements allow people to live longer, with many reaching their 70s, 80s, and even 90s, the risk of stroke naturally increases in this older demographic.
Consequently, the overall number of strokes may see an uptick due to this age-related predisposition.
While the figures might seem daunting, there are effective strategies we can adopt to halt the escalation. In a recent interview, Dr Sudhir Kumar highlighted the importance of lifestyle changes to combat the risk of stroke.
A report from the World Stroke Organization and the Lancet Neurology Commission has emphasised the critical role of evidence-based, pragmatic solutions in combating this looming crisis. It calls for implementing and rigorously monitoring the Commission’s recommendations, which could lead to significant reduction in stroke incidence.
Some key evidence-based recommendations from the Commission include:
Adding to these, Dr Sudhir Kumar says that there is a pressing need for governments to adopt proactive measures, like implementing stricter laws around smoking and alcohol consumption.
“To tackle environmental contributors, governments should invest in reducing air pollution, bolstering public transportation systems, and fostering eco-friendly alternatives. The creation of more parks and public spaces becomes essential, not only as green lungs for cities but also as venues where citizens can walk, exercise, and children can play, thus promoting physical activity,” he adds.
Taking a leaf out of Hyderabad’s book — with the recent inauguration of dedicated cycling and jogging tracks — he says that such tracks should be replicated across cities. Additionally, levying higher taxes on ultra-processed foods and soft drinks, coupled with stringent regulations on their marketing, can deter their rampant consumption.
He stresses that it is high time celebrities became responsible about endorsing products, with those promoting unhealthy choices facing penalties. Collectively, such governmental actions can significantly reshape public health outcomes and reduce stroke risks.
