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Heart of the Matter

Are you the worrying, hypertense kind, given to smoking and drinking to relieve your tensions? Do you suffer from diabetes, high cholestrol and are a regular with contraceptive pills? And more importantly are you a young adult falling in the 40 - 50 years are group? If so, then be warned because all these conditions are a precursor to one of the medical conditions of modern times - the dreaded stroke.

Stroke is a major cause of mortality and morbidity throughout the world and hypertension accounts for more than 90 percent cases where more and more under 50 year olds are falling prey. The incidence of stroke was earlier associated with advancing age with more men than women suffering an attack. In US 500,00 new cases of stroke are reported every year, with 400,00 needing hospitalisation. But in recent times stroke has become a great leveller.

In India it continues 9 - 30 percent of total neurological admissions with a mortality rate of 17.2 per cent. And while the developed world has managed to curb the incidence, in India, where it claims more victims than any other ailment,, lack of effective epidomological data and supportive infrastructure has ensured that mortality rate will continue to rise.

There is no reliable epidpmological data on a national level on the incidence of stroke related mortality and morbidity. The result is an increase in stroke related deaths, says Dr. Vinod Puri, professor of neurology, G. B. Pant hospital.

At a recently concluded symposium on issues and controversies in clinical neurological practice, specialists and neurological scientists from all over the country rued the fact that poor control of the risk factors and social taboos had in no small measure contributed to the the spurt in stroke - related deaths in the country. In the absence of proper data, planning of resource allocation becomes difficult. Natonal agencies like Indian Council of Medical Research and Central Scientific and Industrial Research need to gear up to get a comprehensive national data on stroke which will be of immense help, says Dr. Puri.

He said that stroke incidence both ischemic (resulting from hypertension, diabetes, high cholesterol, cardio-vasculitis or disorder of blood vessels, blood abnormality) and haemorrhagic (caused by hypertension, smoking, drinking and use of recreational drugs like cocaine) is on the decline in the West on account of better control of the risk factors. This he said could be achieved by adopting preventive strategies both at the public level through awareness programmes as well as the medical profession.

In India public awareness on matters of health is negligible. How many of us know that one tablet of Aspirin goes a long way to prevent ischemic stroke as well as a heart attack. But on the other hand there are reports saying that long term use of Aspirin has been found to cause increase in incidence of brain haemorrhage, Or excessive use of contraceptive pills, use of recreational drugs like cocaine, smoking and high intake of alcohol can just engineer a haemorrhagic stroke - 50 percent people die within a month and only 12 - 15 percent may lead normal lives or suffer a minor handicap. But in such a situation the morbidity goes up to 85 percent which is a drain on both mental physical and economic resources of the patient and his family. Proper management as well as regular intake of medication for hypertension will help to prevent occurrence of haemorrhagic and ischemic stroke. But does the public know about this, is there any effort to educate them on these serious health concerns? Dr. Puri queried.

In a scenario like this management of the problem and the ailment acquires utmost urgency, "Public awareness on health issues will go a long way to reduce the occurrence and proper management of stroke. It will also lessen the economic burden on society for the treatment and rehabilitation of the patients, Dr. Puri said.

As a small but decisive step towards overcoming this big hurdle of poor risk management as well as spreading the word around on the issue, the Delhi Neurological Association has set up a stroke registry centre based at GB Pant hospital, which will collate and provide hospital based data on stroke for the National Capital Territory.

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