According to Dr. MM Mehndiratta, one of the Indian authors of the Lancet report and the head of the stroke team at Dr. BL Kapur Hospital, the main factors contributing to this increase in young adult brain strokes are hypertension, excessive smoking, and the overconsumption of salt and sugar.
A recent Lancet Commission report indicates a disturbing forecast for brain strokes, with an expected 50% increase in cases over the next 30 years, potentially leading to 10 million annual fatalities by 2050. This trend could result in a staggering economic loss of $2.3 trillion. What’s concerning is that more than half of these strokes would result from brain bleeds rather than clots. This underscores the critical role of lifestyle factors, such as hypertension and smoking, in stroke prevention.
India, among the Southeast Asian countries, faces the highest stroke incidence, with nearly 1.3 million people suffering strokes each year, and 9.6 million individuals living with stroke-related consequences. A particularly alarming statistic reveals that between 18% and 42% of stroke patients succumb within a month.
Uncontrolled hypertension at younger ages (accounting for 30% of cases in India), the absence of acute stroke care facilities, and a lack of rehabilitation centers are the primary reasons behind the increasing number of stroke-related deaths and disabilities. Moreover, there is a notable lack of awareness surrounding strokes, as highlighted by Dr. MM Mehndiratta, one of the Indian authors of the Lancet report and head of the stroke team at Dr. BL Kapur Hospital.
To mitigate the risk of stroke and prevent mortality, several crucial steps can be taken. Firstly, it is essential to prevent the occurrence of a stroke. While certain factors, like aging, cannot be controlled, three key factors—high blood pressure, diabetes, and high cholesterol levels—can be managed. Maintaining a healthy diet, regular exercise, and controlling obesity are effective preventive measures.
The second critical intervention involves recognizing the symptoms of a stroke and reaching a hospital promptly. It is vital for stroke patients to reach a well-equipped medical facility within 4.5 hours, if not sooner. Unfortunately, many individuals dismiss the early signs of a stroke, attributing their numbness or weakness to unrelated causes, and thus delay seeking medical care. For strokes caused by clots blocking narrow blood vessels, medical practitioners can either administer medication to dissolve the clot or perform a procedure to extract it. For bleeding-induced strokes, immediate action is required to stop the bleeding.
While access to treatment and its cost can be challenging in various parts of India, even in facilities where treatment is available at no cost, the critical time window is often missed.
Recognizing the signs and symptoms of a stroke is of utmost importance. Dr. Mehndiratta suggests remembering the FAST acronym: Facial drooping, Arm weakness, Speech difficulties, and Time to seek help. Typically, individuals experiencing a stroke will be unable to control one side of their face, resulting in an uneven smile. They may also have arm weakness, making it difficult to lift one arm, and their speech may become slurred. Anyone recognizing these symptoms should immediately proceed to the hospital. While stroke awareness is increasing in major cities like Delhi, it is essential to extend this knowledge to a larger audience to save lives.
Other conditions like sickle cell disease and anemia may also lead to strokes, and these underlying conditions should be diagnosed and treated adequately.
Globally, over half of stroke-related deaths will be caused by brain bleeds rather than clots, underscoring the importance of controlling lifestyle factors such as hypertension, diabetes, obesity, cholesterol levels, and smoking. In Southeast Asia, “young strokes” in individuals under 45 years of age are becoming more common, primarily due to the growing prevalence of lifestyle disorders.
In India, hypertension accounts for 30% of stroke cases, while ambient air pollution contributes to 25.5% of cases. The study also identifies unique mechanisms for strokes in many Southeast Asian countries, including infections like scrub typhus, malaria, and dengue. These infections can lead to blood clot-related strokes in cases of brain tuberculosis, with a significant burden of tuberculosis in the region. Additionally, rare risk factors include snakebites, scorpion stings (especially Indian Red scorpion stings), and strokes occurring during toileting. Alarmingly, almost half of the strokes in India occur in the early morning, with a third taking place in the bathroom.
The report indicates that while stroke-related deaths among individuals over 60 years old are projected to decrease by 36%, the decline is less pronounced for younger age groups. Among those under 60 years old, a reduction of less than 25% is predicted, with the number of fatalities expected to decrease from 13 per 100,000 to 10 per 100,000. The persistence of stroke-related deaths in younger age groups is largely attributed to increasing rates of diabetes and obesity in these demographics.
