Stroke Helpline: 0303 3033 100 Website: stroke.org.uk

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 Bangladeshi, Indian, Sri Lankan or Pakistani origin. This factsheet explains the main risk factors for South Asian people and explains what you can do to reduce your risk of stroke.

What is a stroke? acial weakness F Can the person smile? A stroke is a brain attack. A stroke happens Has their mouth or eye drooped? when the blood supply to part of the brain rm weakness is cut off. This can be because of a blockage A Can the person raise both arms? (called an ischaemic stroke) or because peech problems of bleeding in the brain (a haemorrhagic S Can the person speak clearly and stroke.) A transient ischaemic attack (TIA) understand what you say? is very similar to a stroke, but the effects are ime to call 999 temporary – they may last for a few minutes T Stroke is a medical emergency. or up to 24 hours. If you see any one of these signs, seek Within the first few hours there is no way of immediate medical attention. telling whether it is a stroke or TIA occurring, so it is important that you never ignore a TIA. What are the main risk factors for stroke? What are the symptoms of stroke? There are many risk factors that can cause you to have a stroke. Some of these cannot The FAST test (right) can help you to be changed, for example family history, age, recognise the symptoms of a stroke or gender or other additional genetic factors TIA. They usually come on suddenly. Other such as your ethnic group. Research has symptoms include sudden weakness shown that people from African-Caribbean or numbness on one side of the body, and the South Asian communities are at sudden loss or blurring of vision in one or a higher risk of stroke. We still don’t fully both eyes, sudden confusion, dizziness or know why, but it is suggested that some unsteadiness. medical conditions that are risk factors for stroke are more common in these ethnic

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groups. Other factors that can increase your - the first figure (systolic) is the pressure risk of stroke (such as medical conditions when the heart beats and forces blood round like high blood pressure and diabetes, and the body, and the second figure (diastolic) poor lifestyle choices) can be controlled to is the pressure between heart beats. All minimise your risk. adults should have their blood pressure checked at least once every five years and Medical conditions more often if you have had a high reading in the past or you are already on blood High blood pressure pressure medication. Blood pressure levels Blood pressure is the measure of force with vary throughout the day. For example, they which the blood presses on the artery walls can be higher if you have been exercising as it is pumped around the body. Anyone or you are feeling stressed or anxious. So can have high blood pressure (this can also to get an accurate reading it will need to be be known as hypertension), however the checked over a period of time, to see if it is only way to find out if you have high blood consistently high. pressure is by getting it checked. The ideal recommended blood pressure There is no single cause of high blood level is less than 120/80mmHg, but a normal pressure and many factors such as not doing blood reading is less than 130/80mmHg. enough exercise, being overweight, a high You are usually considered to have high salt intake and an unhealthy diet can all blood pressure if you have a measurement contribute to it. Your genes can be another that is consistently above 140/90 mmHg If factor. You have a higher risk of developing you have diabetes, treatment will usually high blood pressure if one or both of your be considered if your blood pressure is parents have experienced it. If you are from consistently above 130/80 mmHg. See South Asian descent, you are more likely factsheet F6, High blood pressure and stroke to have high blood pressure. About one in for further information. four South Asian adults in England have high blood pressure. Diabetes Diabetes is a common condition in the High blood pressure is very common. It’s South Asian community. If you are part one of the biggest risk factors for stroke. If of the South Asian community in the UK you have high blood pressure, your heart will you are five to six times more likely to have have to work harder to pump blood around diabetes than the rest of the UK population. your body and this can put a strain on your heart. Increased pressure can also damage Diabetes occurs when the sugar levels the walls of your arteries which may result (glucose) in your blood are too high. There in blockages or cause the arteries to split. are two main types. Type 1 usually begins in This can result in a stroke. Making lifestyle childhood or adolescence. It develops when changes can help to lower your blood the body stops producing insulin, a hormone pressure, and your doctor may prescribe that helps control the glucose in your medication to help. bloodstream. Type 2 diabetes is much more common and tends to develop gradually Blood pressure is measured by two numbers after the age of 40. It develops when your

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body does not produce enough insulin or large amounts of alcohol when your body’s cells do not react to the •• your ethnic group - for example, if you insulin. are of South Asian origin then you are more likely to be at risk of having high Common symptoms of diabetes include cholesterol. This may be linked to the fact thirst, passing a lot of urine at night, that diabetes and high blood pressure are tiredness and blurred vision. Currently also more common in the South Asian there is no cure for diabetes, but it can be community. managed by making lifestyle changes (see next section). You may also need to take medication, insulin or both to help control it. Lifestyle changes

Diabetes that is not controlled well (called Reducing your risk of stroke untreated diabetes) can cause damage There are many things that you can do to both the large and small blood vessels, to improve your health and help reduce resulting in the blood vessel walls becoming your risk of stroke. These include lifestyle stiff, narrow and furred. This is called changes such as giving up smoking, eating a atherosclerosis. This can increase the healthy diet, taking regular exercise, drinking chance of blood vessels in your brain or sensibly and reducing your stress levels. heart becoming blocked. Having diabetes These changes can help to lower your blood increases your risk of stroke by five times pressure, control diabetes and help lower compared with people who do not have your cholesterol levels. diabetes. See factsheet F15, Diabetes and stroke for further information. Giving up smoking Smoking tobacco doubles your risk of High cholesterol stroke and this risk will increase the more Cholesterol is a fatty substance found in you smoke. Smoking causes arteries to the body. It is important as it has various become furred up (atherosclerosis) and it functions, but too much cholesterol makes the blood more likely to clot. Whether can increase your risk of stroke. This is you smoke cigarettes, bidi or shisha, or use because cholesterol can build up in the chewing tobacco such as pann or gutkha, it is artery, restricting the flow of blood to your still harmful to your health and can increase brain, heart, and the rest of your body. It the risk of serious health problems. also increases the chance of a blood clot developing. An ideal cholesterol level is Giving up is not always easy, but there is a under 5mmols per litre. lot of help and support available. People who use NHS support services, rather than A number of factors can contribute to high trying to stop on their own, are up to four cholesterol levels. These include: times more likely to stop smoking. You should have a free local NHS service that •• medical conditions such as high blood can provide medication and support. Many pressure and diabetes services also provide support to help you •• lifestyle factors such as a poor diet, lack of to stop using smokeless tobacco. Speak to exercise, being overweight and drinking your GP for advice about quitting smoking

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or see page 8 for the contact details of this could be that many health and leisure ‘Quitline’. Perhaps occasions such as services do not cater for language and Ramadan, Diwali, Vaisakhi, anniversaries or cultural differences. the birth of a new baby may be good times to stop using tobacco. See our factsheet F19, Taking regular exercise has many health Smoking and stroke, for further information. benefits. It can help to lower cholesterol and blood pressure, help maintain a healthy Drink sensibly weight, strengthen your heart and improve In small amounts, alcohol may help to circulation. This can all help to reduce your reduce the risk of stroke or heart attack, risk of stroke. The recommended amount of but you should have alcohol in moderation. exercise that will help improve your health is Drinking large amounts of alcohol quickly, 30 minutes a day, five to six times a week. often known as binge drinking, can raise Children, however, need a whole hour of your blood pressure to dangerously high physical activity every day. If it is difficult to levels, which is a major risk factor for stroke. do 30 minutes of continued exercise per day, Binge drinking is defined as drinking more it is just as effective to split this into two 15 than double the daily recommended units of minute sessions or three 10 minute sessions. alcohol in one session. Getting active is not just about going to the The Department of Health recommends gym. Walking to the shops or using the stairs that men should consume no more than four instead of a lift could help, or you could try units in one day and women should have no more energetic activities such as swimming, more than three units per day. dancing, cycling, yoga or tai chi. You should always check with your doctor before A unit is equivalent to: starting any exercise programme. (See our resource sheet R7, Exercise and stroke for •• Half a pint of ordinary strength (3-4%) more ideas.) lager, beer or cider •• A small pub measure of spirit, such as gin, Reducing your stress levels vodka or whisky, or Stress can be described as feeling like you •• A standard pub measure of fortified wine are under pressure and whilst a little bit such as sherry or port of stress can be motivating and improve performance, too much can lead to sleeping For more information, see factsheet problems, lack of appetite and lack of F13, Alcohol and stroke. concentration.

Exercise regularly If it is not treated, stress can lead to high Research has shown that in the UK physical blood pressure, one of the risk factors for activity levels are very low within the South stroke. Research has shown that managing Asian community. Some studies have your stress levels can cut your risk of stroke shown that if you are part of a South Asian by a quarter. community you are less like to take part in formal activities such as gym classes Watch your weight or going for a run. Possible reasons for If you are overweight or obese this can

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increase your risk of stroke. Carrying extra Fruits and vegetables weight around your waist makes you more These are an important source of vitamins likely to develop diabetes, heart problems and minerals and it is recommended that you and high blood pressure. This risk seems have five portions of a variety of fruit and to be higher if you are from a South Asian vegetables per day. This can include fresh, community, but we don’t know why. tinned (in water or natural juice), frozen or dried products. Evidence shows that this Studies have shown that although levels of lowers people’s risk of stroke. obesity are quite low for men in most South Asian groups, they still have high waist Carbohydrates to hip ratios (WHR). Therefore they carry Breads, cereals, rice and potatoes are high more weight around their waists. South in fibre, vitamins and minerals. These Asian women have higher rates of obesity carbohydrates should make up about a third and, unlike most European women, tend to of your diet. Wholegrain foods, such as have a high WHR. Eating a healthy diet, brown rice, wholegrain bread and oats, are cutting down on the amount of fat you eat, much healthier than other options such as and taking regular exercise can help you white bread. to lose weight. See your doctor for further guidance. Protein Meat, fish, pulses and dhal are all good Healthy eating sources of protein and you should aim to Eating a healthy balanced diet, containing have two portions per day. Meat is an lots of fruit and vegetables and low in salt excellent source of protein, vitamins and and saturated fat, can reduce your risk of minerals such as zinc, iron, and B vitamins. stroke. It can also help you to lower your It is also one of the main sources of vitamin blood pressure, lose weight and control B12. Try to eat lean cuts of meat and remove diabetes. all the visible fat from them.

There is a diversity of traditions, cultures Another important source of protein is fish, and habits among the UK’s South Asian and it contains many vitamins and minerals. communities. However, there are some Oily fish is particularly rich in omega-3 fatty similarities between certain dietary customs acids. You should aim to eat at least two that can increase your risk of stroke. For portions of fish a week, including a portion example, food fried in butter or ghee and of oily fish. You can choose frozen or canned Asian sweetmeats such as jalebi, ladoo, fish as well as fresh, however be aware that gulab jamun and burfi contain very high both canned fish and smoked fish can be levels of fat and sugar. high in salt.

As with all cooking you can make changes Try to eat lots of beans and pulses as they to make dishes healthier without sacrificing are high in fibre and low in fat. the taste. Altering how food is cooked or the ingredients used, such as reducing salt and Milk and other dairy foods sugar levels or the amount of saturated fat Milk and other dairy products can also used can really help. provide a good source of protein and can

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keep your teeth and bones healthy as they •• Cut down the amount of salt you add to contain calcium. You should choose semi- food in cooking and at the table. skimmed or skimmed milk, low fat or diet •• Cut down on salty snacks such as crisps, yoghurts and have low fat cheeses such as Bombay mix and salted nuts, which are cottage cheese, curd cheese or edam. When often high in fat too. making lassi, paneer, yoghurt or puddings •• Flavour food with other spices, herbs, use semi-skimmed milk. lemon juice or vinegar instead of salt. •• Eat less Asian pickles (achaar) as they are Fats and sugars high in salt. Sugar and fats provide energy for the body, •• Add extra grated or chopped fruit and but if you eat too much of them, they will vegetables to raitas. increase your weight. There are different types of fat. Saturated fats are found in See our factsheet F8, Healthy eating and butter, ghee, full fat milk, processed meats, stroke for more information on cholesterol, pastries and cakes and can increase your salt and tips for healthy eating. cholesterol levels if you eat too many. Unsaturated fats work in the opposite Are there any other risk factors way as they can help lower cholesterol and for stroke? provide you with essential fatty acids that can help you stay healthy. These are found Atrial Fibrillation (AF) is a type of irregular in foods like oily fish, seeds and nuts. heartbeat. It can lead to blood clots forming in the heart. These clots can then move Salt away and be carried to the brain where they Whilst you do need some salt in your diet, can cause a stroke. Treatments for AF vary, too much salt can increase your blood but an important part of it is reducing the pressure. In the UK, we eat about 9g of salt risk of stroke, often using blood thinning a day. The recommended amount is no medication such as warfarin. See factsheet more than 6g a day. Most of the salt we eat F26, Atrial fibrillation (AF) and strokefor more is ‘hidden’ in processed foods such as ready information. made meals and sauces, bread and salty snacks. Although stroke in younger women is uncommon, research has shown that women Healthy eating tips who take the combined contraceptive pill, which contains both oestrogen and •• Try preparing your food in a healthier progesterone hormones, may be at an way such as steaming, boiling or grilling increased risk of stroke. This is because instead of frying. the ‘pill’ can increase blood pressure levels •• Cut down on fried foods such as samosas, and the oestrogen in the pill can make the pakoras, chips and fried breads. blood more likely to clot. You may be at a •• Try replacing ghee and butter with olive oil higher risk if you are over 35 years of age, if or nut/seed oils. you smoke or if you already have high blood •• Save sweets such as kulfi, halva and burfi pressure. for special occasions as they contain high levels of fat and sugar. Similarly hormone replacement therapy

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(HRT) can increase your blood pressure and Confederation of Indian organisations the risk of your blood clotting. (UK) Stroke project Website: www.ciostrokeproject.co.uk If you have any questions about the The CIO’s aim is to ensure that the needs of contraceptive pill or HRT talk to your GP. the South Asian communities are included (See factsheet F38, Women and stroke to find within national and local policy and services. out more.) Diabetes UK Careline: 0845 120 2960 Email: [email protected] Useful organisations Website: www.diabetes.org.uk Provides information and support for people All organisations listed are UK wide unless affected by diabetes. otherwise stated. Food Standards Agency Stroke Association Website: www.eatwell.gov.uk Stroke Helpline: 0303 3033 100 Provides advice and information on healthy Website: stroke.org.uk eating, understanding food labels and how Contact us for information about stroke, food can affect your health. emotional support and details of local services and support groups. NHS Asian Tobacco Helplines Urdu: 0800 169 0881 Blood Pressure Association Punjabi: 0800 169 0882 BP Info Line: 0845 2410989 Hindi: 0800 169 0883 Website: www.bpassoc.org.uk Gujarati: 0800 169 0884 Works to lower the nation’s blood pressure Bengali: 0800 169 0885 and tries to prevent stroke and heart For information and support with stopping disease. A range of publications is smoking. available. Quitline British Heart Foundation (BHF) Smoking Helpline: 0800 00 22 00 Helpline: 0300 330 3311 Website: www.quit.org.uk Publications Order Line: 0870 600 6566 Website: www.bhf.org.uk QUIT in other languages: The Heart Helpline provides information Bengali (Mon): 0800 00 22 44 from cardiac nurses on heart and health Gujarati (Tue): 0800 00 22 55 issues. Has a wide range of publications on Hindi (Wed): 0800 00 22 66 heart conditions and blood pressure. Punjabi (Thu): 0800 00 22 77 Urdu (Sun): 0800 00 22 88 British Nutrition Foundation Turkish and Kurdish (Thur and Sun): Email: [email protected] 0800 00 22 99 Website: www.nutrition.org.uk Help and support for giving up smoking. Information on nutrition and healthy eating.

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South Asian Health Foundation Tel: 020 8846 7284 Email: [email protected] Conducts healthcare research in the South Asian community and promotes campaigns on health issues.

Weight Concern Tel: 020 7679 1853 Email: [email protected] Website: www.weightconcern.org.uk Charity with advice and information on healthy eating and weight loss.

Disclaimer: The Stroke Association provides details of organisations for information only. Inclusion in this factsheet does not constitute a recommendation or endorsement.

Produced by the Stroke Association’s Information Service. For sources used, visit stroke.org.uk © Stroke Association Factsheet 32, version 02 published March 2011, updated April 2012 (next revision due June 2013). Item code: A01F32

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