Publications

Introduction

Stroke remains a global health concern with high morbidity and mortality. The past three decades have seen a 70% increase in stroke cases and a 43% increase in stroke deaths globally.1 India has a high burden of stroke, attributable to its large population and epidemiological shift and also to a high prevalence of risk factors.2–4 High recurrent stroke rates, which range from 15% to 21% in population and hospital-based registries, are a substantial factor in the stroke burden in India.5–7 Together, recurrent stroke and coronary artery disease are the major predictors of mortality in India, and with 60% mortality at 1 month post stroke.8

Hypertension, diabetes mellitus, smoking, inadequate physical activity, cardiac causes, dyslipidaemia, obesity, and alcohol consumption are some of the major risk factors for stroke globally.9 Use of secondary prevention medicines for stroke and other cardiovascular diseases is low across the world, especially in low-income countries.10 There are several barriers and challenges in the secondary prevention of stroke in low-income and middle-income countries.11 Inadequate control of blood pressure, blood sugar and lipid concentrations, and lifestyle factors are all salient causes for recurrent strokes. Non-availability of medicines, poor drug compliance, poor awareness about stroke prevention, and out-of-pocket expenses for treatment are important barriers in delivering stroke preventive measures.