Stroke in young Indians: Alarming rise linked to lifestyle changes

Although regarded as a disease of old age, stroke is now being increasingly diagnosed in younger populations in India. This change is not anecdotal but is a wider epidemiological transition due to the rapid change in lifestyles. According to the Indian Council of Medical Research, India reports close to 1.82 million-2 million new stroke cases each year with stroke being a leading cause of death in India (7-9% of total deaths). Worryingly, 10-15 percent of these cases are seen in patients who are below the age of 45, with some urban tertiary centres reporting up to 20-25 percent in patients under 50, putting India among countries that have excessively high stroke burden in younger age groups.The increase in the stroke occurring at a young age is closely related to the change in the lifestyle and dietary and occupational habits of the young Indians. Almost half of the population are not exercising as recommended, especially in urban areas where people are sitting most of the time, participating in little exercise and engaging in heavy screen time; this is contributing to obesity, poor vascular health and metabolic dysfunction; which are major predisposing factors of stroke. Meanwhile, the nutrition environment in India has changed in such a way that it is now dominated by processed, high salt and fat diets, which have resulted in an epidemic of hypertension with 20 percent of young adults and 30 percent of elderly people experiencing hypertension.At the same time, the nutrition environment in India has changed in such a manner that it now becomes dominated by processed, high salt and fat diets and as a result has led to a surge in hypertension with 20 percent of young adults and 30 percent of older people experiencing hypertension. Dyslipidemia, as well, today is found in about a quarter of young people. To this is added the fact that diabetes is becoming more and more a burden, with over 100 million diabetics, as estimated by the International Diabetes Federation, India is witnessing early-onset metabolic disease, in which diabetes in the 30s and 40s accelerates atherosclerosis and increases the risk of stroke decades earlier than it would otherwise be.There are over 260 million tobacco users in India and smoking alone doubles or even quadruples the risk of stroke. At the same time, early hypertension and hemorrhagic stroke among young men has been associated with increased alcohol consumption, especially the binge drinking habits. The urban professional life is another risk factor, and chronic stress and sleep deprivation are becoming more widespread. Surveys indicate that more than 60 percent of working people are highly stressed, which contributes to long-term sympathetic activation, high blood pressure, and a prothrombotic condition.In addition to these traditional risk factors, there is a number of new contributors that acquire attention. Air pollution, of which India has some of the highest levels of particulate in the world, is now being attributed to an increased incidence of stroke. The risk is further increasing due to excessive screen time, digital dependence and the increasing prevalence of central obesity, even in individuals with normal BMI, often referred to as the so-called thin-fat Indian phenotype. Moreover, there is an increasing recognition of unrecognized hypercoagulable states in younger patients.Although in urban India the incidence of stroke is higher because of lifestyle issues, the results are worse in rural regions where access to care is delayed and facilities are not ready to handle stroke. But rural India is fast keeping pace as the urban migration to lifestyle is not confined to urban areas. The prognosis of stroke in young adults is especially grim, with almost 3040% of survivors functionally dependent, resulting in long-term disability in their most productive years. The economic impact, both in the form of health care expenses and the loss of income is immense and in many cases devastating to the family.Positively, this trend can be avoided to a great extent. Hypertension, diabetes and lipid disorders should be screened at the young adulthood and at least 150 minutes of weekly physical activity should be encouraged. Increased use of tobacco control measures and workplace interventions in response to stress and sedentary behaviour, and more comprehensive public awareness of the symptoms of stroke and how to respond to them are all necessary steps forward.The increased rates of stroke in young Indian people are not an unavoidable consequence of the modern way of life but a sign of the loss of the previously silent accumulating risks. The statistics are evident, the trend is alarming, and the answer is within reach. There is no better way to prevent the strokes of tomorrow than to address lifestyle factors today because when stroke strikes the young, it is not just a medical issue that it is a generational one.Dr Furqan Khan, Consultant Neurologist at Saifee Hospital