Stroke: The biggest killer and leading cause of disability

KARACHI: Experts at the Aga Khan University write in the Journal of the Pakistan Medical Association that the fact that incidents of stroke are on the rise in Asia is explained by a number of worrying factors. Pakistan is said to be the fourth most populous country in the world in terms of number of diabetic patients while every third person above 45 years suffers from hypertension. Ironically, a great majority of these patients are unaware of what they suffer from, or even if they do, their hypertension is uncontrolled in too many cases.

It barely helps that there are no large-scale studies of the prevalence of strokes in Pakistan exist, so there is no choice but to rely on estimates, which show that around 350,000 patients suffer from a stroke each year. The only published study was conducted among an adult Pashtoon community living in Karachi, which showed a 4.8 percent prevalence of stroke, spread equally between men and women.

This study highlighted a number of risk factors: firstly the high use of table salt, even above that of what is used in cooking. The experts suggest that people reduce the amount of salt in their food and make sure they control hypertension by following their doctor's advice.

Another study they quoted conducted at the community health centre of a tertiary care hospital showed that 39% of people above the age of 18 suffer from hypertension, high cholesterol (known as dyslipidemia) or smoke actively. The same study showed a family history of ischaemic heart disease in 42 percent of these patients, obesity in 24 percent, hypertension in 19 percent, and diabetes mellitus in15 percent of the subjects. The participants were healthy adults for routine preventive checkups. Only 40 percent of hypertensive patients had controlled blood pressure.

The experts say that there are some very simple steps anyone can take to reduce their risk of strokes. The first and most important, they say, is to control blood pressure. Next, quit smoking by taking all the assistance available at various smoking cessation clinics at major hospitals. Third, control weight, diabetes mellitus and hypertension all in one step by adding just thirty minutes a day of physical exercise. This can include walking, jogging, swimming, taking up an active sport or resistance training, or any combination of these choices.

Diabetes mellitus is another important modifiable risk factor for stroke. Pakistan currently has more than 5 million diabetic patients, a figure which is expected to rise by 3.9 millions by 2020, making Pakistan the fourth most populous country accommodating patients with diabetes mellitus. According to the National Health Survey, one quarter of all those over 45 years in Pakistan suffer from diabetes mellitus and a further analysis shows that there are significant ethnic differences, i.e. prevalence is highest among Muhajirs and lowest among the Baloch.

Ischaemic heart disease is a vascular disorder very similar to stroke, since it shares the same underlying causes and also increases the risk of strokes.

The National Health Survey of Pakistan shows that 25 percent of the country's population is overweight or obese, being above the Asian-specific BMI cut-off of 23 kg per metre squared, while 10.3 percent are obese. Obesity is far more prevalent among urban residents than among rural residents. When gender and ethnic factors are analysed, it is found that Sindhi women have the greatest waistlines in the country while Sindh men have the smallest.