What is Stroke?

The WHO definition of stroke is, “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin”.

Causes of Stroke and Cardiovascular Diseases

Tobacco, alcohol use, physical inactivity and unhealthy diet low in fruit and vegetables are risk factors that lead to metabolic risk factors like obesity and overweight, high blood pressure and high blood cholesterol and high blood sugar. These increase the risk for strokes and other cardiovascular diseases, and are all preventable risk factors.

Burden of Stroke

Globally stroke is the second leading cause of death in adults and two-thirds of these deaths occurred in people living in developing countries. Stroke is a leading cause of disability and death in low-income and middle-income countries, and the Global Burden of disease study 2010 estimates that 68.6% incident strokes, 52.2% prevalent strokes, 70.9% stroke deaths, and 77.7% DALYs lost has occurred in these countries. It has been projected to cause 23 million first-ever strokes, 77 million stroke survivors, 61 million DALYs, and 7.8 million deaths by 2030 in low and middle income countries. Thus it has significant socioeconomic consequences for patients, care givers and also health services.

What is the Stroke Burden in India?

In India, magnitude of the burden of stroke has been estimated from prevalence surveys (1970s to 1990s) and incidence measurements (after 2000s). Studies in India had adapted the WHO STEPS Stroke surveillance system to generate stroke event rates, risk factor profile, mortality rates. Recently Population based stroke registries (ICMR Task force studies) in Ludhiana and rural Bengaluru have been conducted to measure stroke incidence rates. Table below depicts the stroke burden in India (adapted from Taylor FC, Sureshkumar K. Stroke in India Factsheet, 2012)

Stroke Burden in India - Fact Sheet

  • Comprehensive information on incidence rates and stroke mortality in India is lacking
  • Long term stroke surveillance in defined populations is necessary for systematic planning of health services and understanding risk factor and disease profile

How can Stroke be Diagnosed and Managed?

Stroke is a clinical diagnosis and Imaging studies support and corroborate the diagnosis of stroke. Early intervention for acute stroke with equipped thrombolysis facilities and prompt referral services is the need of the hour. Measures for secondary prevention of recurrent stroke are also necessary. Long term rehabilitation services to limit disability are also needed for comprehensive management of stroke patients.

How to Control and Prevent the Burden of Stroke Incidence and Disability?

Good data on the burden of stroke, pattern of disease and risk factors can guide in devising management strategies for the control and prevention of stroke. Stroke surveillance in India needs to be strengthened. The Population based Stroke registries of the National Stroke Registry Programme of the ICMR is a first step towards this.

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS) initiated by the Government of India is focusing on early diagnosis, management, infrastructure, public awareness, and capacity building at different levels of health care for all the non-communicable diseases including stroke. Stroke can be prevented to a large extent as there are several modifiable risk factors (physical activity, healthy diet, tobacco cessation and avoiding alcohol use). These can be encouraged at the individual level and community through public awareness, policy measures, supportive environments and a multi-sectoral approach to tackle the rise in disease incidence.