Over 30% of ischemic stroke cases in India are caused by atherosclerosis (thickening of arteries because of plaque build-up) of the arteries supplying blood to the brain, according to the data from the Indo-US Collaborative Stroke Project, a multi-centric study conducted in five high-volume tertiary care centres in India, including the Sree Chitra Tirunal Institute for Medical Sciences and Technology.
The study, based on data collected from 2,066 inpatients with ischemic stroke, has drawn attention to the urgent need to address modifiable vascular risk factors in India, particularly smoking and hypertension, in order to reduce the burden of mortality and morbidity due to stroke.
The Indo-US Collaborative Stroke Project, funded by the US National Institutes of Health and the Department of Biotechnology, India, is the first comprehensive prospective study done on stroke amongst the Indian population.
ADVERTISEMENT
The second most common cause of ischemic stroke was reported to be cardioaortic embolism (25%), caused by clots which originate in the heart, the debris of which may get dislodged and obstruct blood flow to the brain.
Age factor
The study reported that the mean age of stroke incidence in India is 58 years, which is much lower than that in Western population and suggests a significant financial burden from stroke.
ADVERTISEMENT
Interestingly, the percentage of women with stroke — 33% — is also lower than the Western population, reflecting a cultural bias, as men are more likely to seek medical intervention.
Stroke also resulted in significant morbidity among the population, with 44% of the patients becoming disabled for life after stroke.
The data revealed hypertension (61%), diabetes (36%) and tobacco use (32%) to be the major risk factors, which are also much higher than that in the West. Small artery diseases accounted for 15% strokes. In 20-30% of cases, the cause remained undetermined.
P.N. Sylaja, Professor of Neurology, who is in charge of the Comprehensive Stroke Care programme at the SCTIMST and one of the lead investigators, said that the data suggested a large burden of untreated risk factors, especially hypertension, in Indian population.
The earlier, the better
“Significantly, only 1.7% patients reached hospitals using ambulance facility, indicating that people still do not consider stroke as an emergency. The earlier patients are brought to hospitals, the better chance of avoiding death and disability,” she said.
The other centres which were part of the study included Massachusetts General Hospital, Boston, U.S.; All India Institute for Medical Sciences, New Delhi; Nizam’s Institute of Medical Sciences, Hyderabad; Christian Medical College, Ludhiana; and Postgraduate Institute for Medical Education and Research, Chandigarh. The study appears in the November issue of the journal Stroke.