A stroke is no longer considered a health risk for only older people. An analysis by the Indian Council of Medical Research, based on data from the National Stroke Registries, found that nearly one in every seven stroke patients in India is under 45 years. A study published in the Indian Journal of Medical Health also revealed that strokes are becoming the second leading cause of sudden death among Indians under 45 years, with a higher incidence among men as compared to women (4.5:1).
Anyone can suffer a stroke, a medical emergency that occurs when blood flow to the brain is blocked (ischemic) or a blood vessel bursts (hemorrhagic), causing rapid brain cell death. While it’s true that the risk increases with age, strokes in young people – especially those under 45 years – are becoming more common.
Buildup over years
Heart disease is becoming the leading cause of death in Indians, but it is not something that suddenly appeared overnight, says Dr (Col) Joy Dev Mukherjee, chairman and head, neurology, Max Super Speciality Hospital, Saket, New Delhi. “It is the result of a long-standing risk that has been building up over years. However, it has clearly accelerated in the last decade due to major lifestyle changes,” he adds.
While it is a well-known fact that Indians develop heart diseases nearly 8-10 years before their European and other Western counterparts do, what we are seeing now is a much sharper rise in young patients – especially after 2020 – largely because of stress, sedentary work culture, poor sleep, processed food intake, and undiagnosed hypertension and diabetes, explains Dr Mukherjee.
Dr Pravin Kahale, consultant, cardiology, Kokilaben Dhirubhai Ambani Hospital in Mumbai echoes Dr Mukherjee’s observations. “There has been a gradual shift in lifestyle in people under 45 years. It can be considered a compounding health risk that develops over a period of time,” he says. Among Indians, the major causes of heart disease or stroke widely include diabetes, prediabetes, hypertension, smoking, high cholesterol and a family history of heart disease, he adds.
Within the under-45 category, the 30-44 age group is the most affected. “This is the age when professional stress peaks, lifestyle becomes irregular, and health often takes a back seat,” says Dr Mukherjee, adding: “Earlier, heart attacks were mostly seen in people in their late 50s or 60s. Now we are seeing cases even in the late 20s and 30s – particularly among urban professionals.”
Incidentally, many of these strokes are first-time events in patients who never knew they had hypertension or diabetes. “A significant number comes from high-stress professionals with long working hours and irregular sleep,” he points out.
Ischemic strokes are the most common among young adult persons experiencing strokes, followed by heart disease caused by cholesterol-related abnormalities, say doctors. According to a study published on stroke incidence in India in the Lancet, the most common subtype of stroke reported in earlier studies was ischemic stroke with an incidence of 65-84%, with intracerebral haemorrhage (ICH) making up 11-35% of the cases.
In fact, as per a study on under-40 (years of age) strokes by Manipal Hospitals, ischemic strokes make up almost 85% of all the cases. These strokes are described as occurring when arteries supplying blood to the brain get blocked due to blood clots. “Immediate medical intervention using clot-busting drugs is needed in treating this type of stroke to help prevent serious brain tissue damage and disability,” the study adds.
Haemorrhagic stroke is another type of stroke, albeit less common in Indian populations – these occur when internal bleeding happens because of a brain vessel that has weakened to the point of bursting. Mini strokes or transient ischemic attacks (TIA) pose less of a danger of sudden death, and is a temporary blockage of blood flow to the brain, which resolves itself in minutes usually. These TIAs can be signs of future risk of stroke or heart disease and should be screened or diagnosed immediately.
Research shows that strokes strike 10% to 15% of people who are under 40 years old. More precisely, stroke affects 46 out of 100,000 young adults annually within the specific age bracket of 18-49 years, the Manipal study notes.
Early detection is key
Dr Kahale points to the unhealthy lifestyle habits that contribute to the incidence of strokes or the vulnerability to heart disease among young adults. “Certain habits can increase the risk of heart disease. Smoking is one of them. Lack of physical activity or exercise is also an important preventable cause,” he says, noting, “Nowadays it is often said that sitting is the new smoking because of the risks linked to prolonged inactivity.”
Dr Mukherjee adds to this list, emphasising some other common causes – high blood pressure or hypertension (which often goes undiagnosed), diabetes or prediabetes, high cholesterol, smoking, consuming smokeless tobacco, excess alcohol consumption, obesity and excess abdominal fat, as well as chronic stress and sleep deprivation.
Getting a little more specific, Dr Mukherjee enumerates a few health conditions predisposing Indians in particular to risk of heart disease and stroke. These include higher levels of lipoprotein (a), which is a type of LDL cholesterol, elevated homocysteine (referring to metabolic disruptions due to certain vitamin deficiencies, sleep apnea (breathing trouble during sleep), rheumatic heart disease (chronic condition causing damage to heart valves), certain clotting disorders and, most pertinently, hypertension.
Dr Kahale holds that small but consistent lifestyle changes can help to keep the risk of heart disease and stroke at bay. He says, “Regular exercise and a healthy diet can help reduce the risk of heart disease. A diet that is low in carbohydrates and includes less processed food may be beneficial.” Additionally, he advises precautionary screening tests as well: “Screening tests include measurement of body mass index or body weight, abdominal circumference, fasting blood sugar and a lipid profile.”
Dr Mukherjee serves up an optimistic yet surprising statistic given the state of affairs when it comes to the health burden of early onset strokes or heart disease in the country. He says that 80-90% of strokes are preventable.
“Prevention does not require extreme measures. It requires consistency,” he asserts. In addition to daily lifestyle habits like sleep and physical exercise regulation and health screenings of blood pressure, cholesterol and diabetes, he also adds, “Recognising stroke symptoms early is also crucial.”
The World Health Organization (WHO) makes it easy to identify the symptoms of a stroke, using the acronym ‘FAST’, which stands for face drooping, arm weakness, speech difficulty, and time to reach hospital immediately. Dr Mukherjee stresses repeatedly that early detection can significantly change outcomes when it comes to heart disease. He further advises that everybody get a few basic tests once they hit the age of 30, if not earlier, even if they do not notice any symptoms, which include a blood pressure check (at least yearly), fasting blood sugar or HbA1c, lipid profile, ECG, sometimes TMT or ECHO, if at high risk, and additional tests like lipoprotein(a), if there is a strong family history.
Disclaimer: The information in this article is for educational and informational purposes only and is not intended as medical advice. While the author has incorporated expert medical guidance while producing the story and ensured full authentic information is provided to the reader, you should always seek the advice of a qualified healthcare provider regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.