Sanjay Khanna was hit by a sudden wave of dizziness while driving home with his wife Sarita in April last year. He just about managed to park his car and stumble up to in their first-floor Patel Nagar home in west Delhi. “I entered the house and collapsed. I’m told that within minutes, I became so disoriented that I couldn’t tell where I was or recognize my wife. My speech became incoherent and soon I couldn’t speak at all,” recalls Khanna, a property consultant.
His family took him to BLK Hospital in central Delhi, where he was diagnosed with an ischemic stroke triggered by clots in the blood blocking blood flow in the brain arteries.
Khanna was given hepatin shots to stop his blood from coagulating. It saved his life. But scans showed two blockages in the carotid arteries that supply oxygenated blood to the head and neck. A carotid angioplasty was done to prop them open at Medanta. Khanna was back to business in a few weeks. “Nothing’s changed, except that I’ve stopped smoking and chewing tobacco,” he says.
Time for action
Treating a stroke as early as possible is crucial to minimise brain damage and subsequent disability. “Each subsequent hour after a stroke in which treatment is not given, the brain loses as many neurons as it would in 3.6 years of normal ageing. Treating stroke in the first few hours can reverse damage in many patients,” says Dr Vipul Gupta, head, interventional neuroradiology, Medanta. “The problem is that the symptoms are generalised and often transient. Awareness is low even among general physicians and most people reach treatment too late,” says Dr Vipul Gupta, head, interventional neuroradiology, Medanta, who did Khanna’s intervention.
As blockages in the arteries in the front part of the brain don’t produce any physical symptoms — the brain’s front controls emotions and behaviour — getting screened is important for people with risk factors.
In Khanna’s case, smoking did the damage. “The attack was a bolt from the dark, I’ve been healthy all my life,” says he. Smoking and drug abuse increases the risk of clot formation (thrombosis) and is among the leading cause of stroke and heart attacks in young people without other risk factors.
Worldwide, stroke is the second leading cause of disability, which may include loss of vision and/or speech, and paralysis.
Just 10 modifiable risk factors are associated with about 90% of strokes, showed data presented at the World Congress of Cardiology this week. Just controlling these risk factors - hypertension, high cholesterol, smoking, physical inactivity, abdominal obesity, heart disease, unhealthy diet, alcohol use, diabetes and psychosocial stressors can save people from disability and death, shows preliminary data from the INTERSTROKE study of more than 27,000 patients from 32 countries.
Of these, hypertension — chronic blood pressure reading over 140/90 mmHg or higher — is the most important risk factor.
Much like heart disease, stroke shows a gender bias in favour of women, occurring less in women aged between 45 and 65 years as compared to men. After 65 years, stroke incidence is the same for women as men.
Two-thirds of all the people that have suffered a stroke live in developing countries. “A rapid rise in the proportion of people with high blood pressure, diabetes and dyslipidemia (high blood fats such as cholesterol), and the relative lack of exercise among the general population, strokes in India are projected to go over 1 million per year,” writes Dr Man Mohan Mehndiratta, director of Neurology at G.B. Pant Hospital, in the international journal Neurology.
Cutting down risk
Apart from a healthy diet and exercise, using medication to keep the risk factors within healthy limits is imperative. Almost one in four heart attack and stroke patients adhered better to prescription and showed significant improvements in blood pressure and cholesterol when prescribed a “polypill”, which is a fixed-dose combination of commonly-used blood pressure and cholesterol lowering medications, along with aspirin, which prevents the blood from clotting.
The Single Pill to Avert Cardiovascular Events (SPACE) project analysed data from 3,140 patients with established heart and stroke risk in Europe, India and Australasia showed a 43% increase in patient adherence to medication at 12 months with the polypill, which leads to better control of blood pressure and bad cholestrol.
“Given the potential affordability, even in low income countries, there is considerable potential to improve global health,” said Dr Ruth Webster, SPACE Collaboration Co-ordinator, George Institute for Global Health, Sydney. “The polypill, however, is not a replacement for a healthy lifestyle and should be combined with tobacco avoidance, a healthy diet and enhanced physical activity,” said Professor Salim Yusuf, President-elect of the World Heart Federation.