Stroke in South Asian people

If you are part of the South Asian community in the UK, you have a higher risk of stroke than the rest of the population, but the reasons for this are not fully understood. The term South Asian means anyone of !angladeshi, Indian, Sri "ankan or #akistani origin. This factsheet e$plains the main risk factors for South Asian people and e$plains %hat you can do to reduce your risk of stroke.

What is a stroke?
A stroke is a brain attack. A stroke happens %hen the blood supply to part of the brain is cut off. This can be because of a blockage &called an ischaemic stroke' or because of bleeding in the brain &a haemorrhagic stroke.' A transient ischaemic attack (TIA) is very similar to a stroke, but the effects are temporary ( they may last for a fe% minutes or up to )* hours. +ithin the first fe% hours there is no %ay of telling %hether it is a stroke or TIA occurring, so it is important that you never ignore a TIA.

What are the symptoms of stroke?

The FAST test &belo%' can help you to recognise the symptoms of a stroke or TIA. They usually come on suddenly. ,ther symptoms include sudden %eakness or numbness on one side of the body, sudden loss or blurring of vision in one or both eyes, sudden confusion, di--iness or unsteadiness. Facial eakness .an the person smile/ 0as their mouth or eye drooped/ Arm eakness .an the person raise both arms/ Speech problems .an the person speak clearly and understand %hat you say/ Time to call !!! Stroke is a medical emergency.
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 1

If you see any one of these signs, seek immediate medical attention.

What are the main risk factors for stroke?

There are many risk factors that can cause you to have a stroke. Some of these cannot be changed, for e$ample family history, age, gender or other additional genetic factors such as your ethnic group. 4esearch has sho%n that people from African5.aribbean and the South Asian communities are at a higher risk of stroke. We still dont fully know why, but it is suggested that some medical conditions that are risk factors for stroke are more common in these ethnic groups. Other factors that can increase your risk of stroke, such as medical conditions like high blood pressure and diabetes, and poor lifestyle choices, can be controlled to minimise your risk.

"edical conditions
#igh blood pressure !lood pressure is the measure of force %ith %hich the blood presses on the artery %alls as it is pumped around the body. Anyone can have high blood pressure &this can also be kno%n as hypertension', ho%ever the only %ay to find out if you have high blood pressure is by getting it checked. There is no single cause of high blood pressure and many factors such as not doing enough e$ercise, being over%eight, a high salt intake and an unhealthy diet can all contribute to it. 6our genes can be another factor. 6ou have a higher risk of developing high blood pressure if one or both of your parents have e$perienced it. If you are from South Asian desent$ you are more likely to have high blood pressure. About one in four South Asian adults in 7ngland have high blood pressure. 0igh blood pressure is very common. t s one of the biggest risk factors for stroke. If you have high blood pressure, your heart %ill have to %ork harder to pump blood around your body and this can put a strain on your heart. Increased pressure can also damage the %alls of your arteries %hich may result in blockages or cause the
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 2

arteries to split. This can result in a stroke. 8aking lifestyle changes can help to lo%er your blood pressure, and your doctor may prescribe medication to help. !lood pressure is measured by t%o numbers. The first figure &systolic' is the pressure %hen the heart beats and forces blood round the body, and the second figure &diastolic' is the pressure bet%een heart beats. All adults should have their blood pressure checked at least once every five years and more often if you have had a high reading in the past or you are already on blood pressure medication. !lood pressure levels vary throughout the day. 9or e$ample, they can be higher if you have been e$ercising or you are feeling stressed or an$ious. So to get an accurate reading it %ill need to be checked over a period of time, to see if it is consistently high. The ideal recommended blood pressure level is less than 2)1:;1mm0g, but a normal blood reading is less than 231:;1mm0g. 6ou are usually considered to have high blood pressure if you have a measurement that is consistently above 2*1:<1 mm0g If you have diabetes, treatment %ill usually be considered if your blood pressure is consistently above 231:;1 mm0g. See factsheet 9=, High blood pressure and stroke for further information. %iabetes >iabetes is a common condition in the South Asian community. If you are part of the South Asian community in the UK you are five to si$ times more likely to have diabetes than the rest of the UK population. >iabetes occurs %hen the sugar levels &glucose' in your blood are too high. There are t%o main types. Type 2 usually begins in childhood or adolescence. It develops %hen the body stops producing insulin, a hormone that helps control the glucose in your bloodstream. Type ) diabetes is much more common and tends to develop gradually after the age of *1. It develops %hen your body does not produce enough insulin or %hen your body s cells do not react to the insulin.

The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk

.ommon symptoms of diabetes include thirst, passing a lot of urine at night, tiredness and blurred vision. .urrently there is no cure for diabetes, but it can be managed by making lifestyle changes &see ne$t section'. 6ou may also need to take medication, insulin or both to help control it. >iabetes that is not controlled %ell &called untreated diabetes' can cause damage to both the large and small blood vessels, resulting in the blood vessel %alls becoming stiff, narro% and furred. This is called atherosclerosis. This can increase the chance of blood vessels in your brain or heart becoming blocked. 0aving diabetes increases your risk of stroke by five times compared %ith people %ho do not have diabetes. See factsheet F15,t Diabetes and stroke for further information. #igh cholesterol .holesterol is a fatty substance found in the body. It is important as it has various functions, but too much cholesterol can increase your risk of stroke. This is because cholesterol can build up in the artery, restricting the flo% of blood to your brain, heart, and the rest of your body. It also increases the chance of a blood clot developing. An ideal cholesterol level is under ?mmols per litre. A number of factors can contribute to high cholesterol levels. These include@ medical conditions such as high blood pressure and diabetes lifestyle factors such as a poor diet, lack of e$ercise, being over%eight and drinking large amounts of alcohol your ethnic group 5 for e$ample, if you are of South Asian origin then you are more likely to be at risk of having high cholesterol. This may be linked to the fact that diabetes and high blood pressure are also more common in the South Asian community.

&ifestyle changes
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 4

'educing your risk of stroke There are many things that you can do to improve your health and help reduce your risk of stroke. These include lifestyle changes such as giving up smoking, eating a healthy diet, taking regular e$ercise, drinking sensibly and reducing your stress levels. These changes can help to lo%er your blood pressure, control diabetes and help lo%er your cholesterol levels. (iving up smoking Smoking tobacco doubles your risk of stroke and this risk %ill increase the more you smoke. Smoking causes arteries to become furred up &atherosclerosis' and it makes the blood more likely to clot) +hether you smoke cigarettes, bidi or shisha, or use che%ing tobacco such as pann or gutkha, it is still harmful to your health and can increase the risk of serious health problems. Aiving up is not al%ays easy but there is a lot of help and support available. #eople %ho use B0S support services, rather than trying to stop on their o%n, are up to four times more likely to stop smoking. 6ou should have a free local *#S service that can provide medication and support. 8any services also provide support to help you to stop using smokeless tobacco. Speak to your (+ for advice about Cuitting smoking or see page < for further details. #erhaps occasions such as 4amadan, >i%ali, Daisakhi, anniversaries or the birth of a ne% baby may be good times to stop using tobacco. See our factsheet F19, Smoking and stroke, for further information. %rink sensibly In small amounts, alcohol may help to reduce the risk of stroke or heart attack, but you should have alcohol in moderation. >rinking large amounts of alcohol Cuickly, often kno%n as binge drinking$ can raise your blood pressure to dangerously high levels, %hich is a maEor risk factor for stroke. !inge drinking is defined as drinking more than double the daily recommended units of alcohol in one session. The >epartment of 0ealth recommends that men should consume no more than four units in one day and %omen should have no more than three units per day.
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 5

A unit is eCuivalent to@ 0alf a pint of ordinary strength &35*F' lager, beer or cider A small pub measure of spirit, such as gin, vodka or %hisky, or A standard pub measure of fortified %ine such as sherry or port 9or more information, see factsheet F13 Alcohol and stroke. ,-ercise regularly 4esearch has sho%n that in the UK physical activity levels are very lo% %ithin the South Asian community. Some studies have sho%n that if you are part of a South Asian community you are less like to take part in formal activities such as gym classes or going for a run. #ossible reasons for this could be that many health and leisure services do not cater for language and cultural differences. Taking regular e-ercise has many health benefits. It can help to lo%er cholesterol and blood pressure, help maintain a healthy %eight, strengthen your heart and improve circulation. This can all help to reduce your risk of stroke. The recommended amount of e$ercise that %ill help improve your health is ./ minutes a day$ five to si- times a eek. .hildren, ho%ever, need a %hole hour of physical activity every day. If it is difficult to do 31 minutes of continued e$ercise per day, it is Eust as effective to split this into t%o 2? minute sessions or three 21 minute sessions. Aetting active is not Eust about going to the gym. +alking to the shops or using the stairs instead of a lift could help, or you could try more energetic activities such as s%imming, dancing, cycling, yoga or tai chi. 6ou should al%ays check ith your doctor before starting any e$ercise programme. &See our resource sheet R7, !ercise and stroke for more ideas.' 'educing your stress levels Stress can be described as feeling like you are under pressure and %hilst a little bit of stress can be motivating and improve performance, too much can lead to sleeping problems, lack of appetite and lack of concentration.
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 6

If it is not treated, stress can lead to high blood pressure, one of the risk factors for stroke. 4esearch has sho%n that managing your stress levels can cut your risk of stroke by a Cuarter. Watch your eight If you are over%eight or obese this can increase your risk of stroke. 0arrying e-tra eight around your aist makes you more likely to develop diabetes, heart problems and high blood pressure. This risk seems to be higher if you are from a South Asian community, but %e don t kno% %hy. Studies have sho%n that although levels of obesity are Cuite lo% for men in most South Asian groups, they still have high %aist to hip ratios &+04' and therefore they carry more %eight around their %aists. South Asian %omen have higher rates of obesity and, unlike most 7uropean %omen, tend to have a high +04. ,ating a healthy diet, particularly cutting do%n on the amount of fat you eat, and taking regular e-ercise can help you to lose %eight. See your doctor for further guidance. #ealthy eating 7ating a healthy balanced diet, containing lots of fruit and vegetables and lo% in salt and saturated fat, can reduce your risk of stroke. It can also help you to lo%er your blood pressure, lose %eight and control diabetes. There is a diversity of traditions, cultures and habits among the UK s South Asian communities) 0o%ever, there are some similarities bet%een certain dietary customs that can increase your risk of stroke. 9or e$ample, food fried in butter or ghee and Asian s%eetmeats such as Ealebi, ladoo, gulab Eamun and burfi contain very high levels of fat and sugar. As %ith all cooking you can make changes to make dishes healthier %ithout sacrificing the taste. Altering ho% food is cooked or the ingredients used, such as reducing salt and sugar levels or the amount of saturated fat used can really help. Fruits and vegetables
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 7

These are an important source of vitamins and minerals and it is recommended that you have five portions of a variety of fruit and vegetables per day. This can include fresh, tinned &in %ater or natural Euice', fro-en or dried products. 7vidence sho%s that this lo%ers people s risk of stroke. 0arbohydrates !reads, cereals, rice and potatoes are high in fibre, vitamins and minerals. These carbohydrates should make up about a third of your diet. +holegrain foods, such as bro%n rice, %holegrain bread and oats, are much healthier than other options such as %hite bread. +rotein 8eat, fish, pulses and dhal are all good sources of protein and you should aim to have t o portions per day. 8eat is an e$cellent source of protein, vitamins and minerals such as -inc, iron, and ! vitamins. It is also one of the main sources of vitamin !2). Try to eat lean cuts of meat and remove all the visible fat from them. Another important source of protein is fish, and it contains many vitamins and minerals. ,ily fish is particularly rich in omega53 fatty acids. 6ou should aim to eat at least t%o portions of fish a %eek, including a portion of oily fish. 6ou can choose fro-en or canned fish as %ell as fresh, ho%ever be a%are that both canned fish and smoked fish can be high in salt. Try to eat lots of beans and pulses as they are high in fibre and lo% in fat. "ilk and other dairy foods 8ilk and other dairy products can also provide a good source of protein and can keep your teeth and bones healthy as they contain calcium. 6ou should choose semi5skimmed or skimmed milk, lo% fat or diet yoghurts and have lo% fat cheeses such as cottage cheese, curd cheese or edam. +hen making lassi, paneer, yoghurt or puddings use semi5skimmed milk. Fats and sugars Sugar and fats provide energy for the body, but if you eat too much of them, they %ill increase your %eight. There are different types of
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 8

fat. Saturated fats are found in butter, ghee, full fat milk, processed meats, pastries and cakes and can increase your cholesterol levels if you eat too many. 1nsaturated fats %ork in the opposite %ay as they can help lo er cholesterol and provide you %ith essential fatty acids that can help you stay healthy. These are found in foods like oily fish, seeds and nuts. Salt +hilst you do need some salt in your diet, too much salt can increase your blood pressure. In the UK, %e eat about <g of salt a day. The recommended amount is no more than =g a day. . 8ost of the salt %e eat is hidden in processed foods such as ready made meals and sauces, bread and salty snacks. #ealthy eating tips Try preparing your food in a healthier %ay such as steaming, boiling or grilling instead of frying. .ut do%n on fried foods such as samosas, pakoras, chips and fried breads. Try replacing ghee and butter %ith olive oil or nut:seed oils. Save s%eets such as kulfi, halva and burfi for special occasions as they contain high levels of fat and sugar. .ut do%n the amount of salt you add to food in cooking and at the table. .ut do%n on salty snacks such as crisps, !ombay mi$ and salted nuts, %hich are often high in fat too. 9lavour food %ith other spices, herbs, lemon Euice or vinegar instead of salt. 7at less Asian pickles &achaar' as they are high in salt. Add e$tra grated or chopped fruit and vegetables to raitas. See our factsheet F", Health# eating and stroke, for more information on cholesterol, salt and tips for healthy eating.

Are there any other risk factors for stroke?

Atrial Fibrillation (AF) is a type of irregular heartbeat. It can lead to blood clots forming in the heart. These clots can then move a%ay and be carried to the brain %here they can cause a stroke. Treatments for A9 vary, but an important part of it is reducing the risk of stroke, often using blood thinning medication such as
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 9

%arfarin. See factsheet F$%, Atrial &ibrillation 'AF( and stroke for more information. Although stroke in younger %omen is uncommon, research has sho%n that %omen %ho take the combined contraceptive pill, %hich contains both oestrogen and progesterone hormones, may be at an increased risk of stroke. This is because the pill can increase blood pressure levels and the oestrogen in the pill can make the blood more likely to clot. 6ou may be at a higher risk if you are over 3? years of age, if you smoke or if you already have high blood pressure. Similarly hormone replacement therapy (#'T) can increase your blood pressure and the risk of your blood clotting. If you have any Cuestions about the contraceptive pill or 04T talk to your (+. &See factsheet F3", )omen and stroke to find out more'.

1seful organisations
All organisations listed are UK %ide unless other%ise stated. Stroke Association Stroke #elpline2 1313 3133 211 Website2 %%%.stroke.org.uk ,mail2 infoGstroke.org.uk .ontact us for information about stroke, emotional support and details of local services and support groups. 3lood +ressure Association !# Info "ine@ 1;*? )*21<;< +ebsite@ %%%.bpassoc.org.uk +orks to lo%er the nation s blood pressure and tries to prevent stroke and heart disease. A range of publications is available. 3ritish #eart Foundation (3#F) 0elpline@ 1311 331 3322 #ublications ,rder "ine@ 1;H1 =11 =?== +ebsite@ %%%.bhf.org.uk
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 10

The 0eart 0elpline provides information from cardiac nurses on heart and health issues. 0as a %ide range of publications on heart conditions and blood pressure. 3ritish *utrition Foundation 7mail@ postbo$Gnutrition.org.uk +ebsite@ %%%.nutrition.org.uk Information on nutrition and healthy eating. 0onfederation of Indian organisations (14) Stroke pro5ect +ebsite@ %%%.ciostrokeproEect.co.uk The .I, s aim is to ensure that the needs of the South Asian communities are included %ithin national and local policy and services. %iabetes 14 .areline@ 1;*? 2)1 )<=1 7mail@ infoGdiabetes.org.uk +ebsite@ %%%.diabetes.org.uk #rovides information and support for people affected by diabetes. Food Standards Agency +ebsite@ %%%.eat%ell.gov.uk #rovides advice and information on healthy eating, understanding food labels and ho% food can affect your health. *#S Asian Tobacco #elplines Urdu@ 1;11 2=< 1;;2 #unEabi@ 1;11 2=< 1;;) 0indi@ 1;11 2=< 1;;3 AuEarati@ 1;11 2=< 1;;* !engali@ 1;11 2=< 1;;? 9or information and support %ith stopping smoking 6uitline Smoking 0elpline@ 1;11 11 )) 11 +ebsite@ %%%.Cuit.org.uk IUIT in other languages@ !engali &8on'@ 1;11 11 )) ** AuEarati &Tue'@ 1;11 11 )) ?? 0indi &+ed'@ 1;11 11 )) ==
The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk 11

#unEabi &Thu'@ 1;11 11 )) HH Urdu &Sun'@ 1;11 11 )) ;; Turkish and Kurdish &Thur and Sun'@ 1;11 11 )) << 0elp and support for giving up smoking. South Asian #ealth Foundation Tel@ 1)1 ;;*= H);* 7mail@ infoGsahf.org.uk .onducts healthcare research in the South Asian community and promotes campaigns on health issues. Weight 0oncern Tel@ 1)1 H=H< 2;?3 7mail@ enCuiriesG%eightconcern.org.uk +ebsite@ %%%.%eightconcern.org.uk .harity %ith advice and information on healthy eating and %eight loss. >isclaimer@ The Stroke Association provides details of organisations for information only. Inclusion in this factsheet does not constitute a recommendation or endorsement.
#roduced by the Stroke Association s Information Service. 9or sources used, visit stroke.org.uk J Stroke Association 9actsheet 3), version 1), published 8arch )122, updated April )12) &ne$t revision due Kune )123'.
Stroke Association is a .ompany "imited by Auarantee, registered in 7ngland and +ales &Bo =2)H*'. 4egistered office@ Stroke Association 0ouse, )*1 .ity 4oad, "ondon 7.2D )#4. 4egistered as a .harity in 7ngland and +ales &Bo )2212?' and in Scotland &S.13HH;<'. Also registered in Isle of 8an &Bo <*?', Kersey &B#, 3=<' and serving Borthern Ireland.

The Stroke Association April )12) Stroke 0elpline 1313 31 33 211 %ebsite %%%.stroke.org.uk

12