Stroke ranks number three as global disease burden after heart disease and cancer. It remains the leading cause of disability in the world.
What causes stroke?
High blood pressure is the most important risk factor for stroke. It is present in more than 70% patients with stroke. Studies have shown that Stroke incidence can be significantly decreased by controlling Blood Pressure. Other risk factors include high cholesterol, cigarette smoking, diabetes, an abnormal heart rhythm called atrial fibrillation, and narrowing of the carotid arteries, which are major blood vessels in the neck carrying blood to the brain.
Is it possible to prevent stroke?
Stroke is a very preventable disease. Reduction of blood pressure alone will reduce the risk of stroke by 40% or more. The risk can be further reduced by controlling the other risk factors listed above.
How many stroke patients are there in Pakistan?
Incidence of stroke in US is about 200 patients per 100, 000 population. In Pakistan, it is believed to be even higher. Despite being a major public health problem, stroke has been ignored by health care authorities. More reliable data are needed to establish the precise burden of stroke in Pakistan. We do know it is the commonest reason for getting admitted to a neurology ward in our country. We also know that high blood pressure, the major risk factor for stroke, is very common in Pakistan. A national health survey revealed that more than 30% population above age 45 is suffering from high BP, most of whom are undiagnosed and uncontrolled. Also, 12% population above age 15 is suffering from high cholesterol, and there are more than 5 million diabetics in Pakistan (#6 in world ranking). It is estimated that there will be 13 million diabetics in Pakistan by 2020 (#4 in world). Estimated stroke incidence in Pakistan is close to 250 per 100,000 population, which means that there are 350,000 new stroke patients every year in this country. Out of all ethnic groups, Pashtuns have the highest prevalence of high blood pressure and stroke.
What are the symptoms of stroke? How does someone that they have a stroke?
Everyone should be aware of the signs of stroke. Sudden onset of weakness on one side of the body, slurring of speech, loss of vision, double vision and sudden onset of difficulty walking are the major signs of stroke. There is now treatment available at some hospitals which must be given within three hours of stroke onset. These medications dissolve blood clots that are blocking blood flow to parts of the brain and if properly used they can reduce disability from stroke.
What should one do if you think someone is having a stroke?
If someone develops these symptoms, they should go to the emergency room of a hospital. These patients should be admitted to hospital, especially in stroke units if available. Up to 25% patients with stroke die if they do not get good initial care after stroke. This could be reduced to 10% by providing good emergency care and in-hospital care in the first 48 hours. As many as 20% patients with disabling stroke have a minor stroke or warning signs a few days or weeks before the stroke. If those patients can be identified, stroke incidence can be reduced.
What is the advice for people who have no risk factors for stroke?
They should check their Blood pressure, blood sugar and blood cholesterol every year if they are above age 40. They should also quit smoking and exercise every day (brisk walk for thirty minutes).
What is the advice for people who have already had a stroke?
These patients are at increased risk of having another stroke. Measures can be introduced that will help prevent future strokes from occurring. This can be done through controlling risk factors and using certain medications. Many patients with stroke become functional within six months if they get the proper care including emergency care, hospital care and rehabilitation. The goal should be that patients should become independent.
What is the purpose of Stroke Society and why is it celebrating “World Stroke Day”?
Pakistan Stroke Society is affiliated with International Stroke Society, a worldwide body devoted to addressing the global burden of stroke. The mission is to improve stroke prevention and stroke care. In Pakistan, the Society is conducting a series of seminars and lectures for doctors and medical students. We are also organizing a public awareness campaign. This is the best way to prevent stroke, by raising public awareness. We are planning to publish Stroke information brochures for public and patients. We are also contacting health care authorities to get Stroke prevention on their agenda.
What should the government and local health departments do?
A National Stroke Prevention program should be established. We already have a TB Control Program, AIDS control program, Malaria control program, and Mental Health Program, but a Stroke prevention program would really affect the mortality and disability related to stroke, which is a huge economic burden. The National stroke prevention program should initiate and coordinate public awareness campaigns, and develop guidelines and research related to stroke in Pakistan. Upcoming National Health Survey should focus on identification of stroke, risk factors and disability related to it. This information will be helpful in future policy making and planning.