Ischemic stroke, which is caused by an obstruction within a blood vessel supplying blood to the brain, accounts for 87 percent of all stroke cases in the U.S., according to the American Heart Association. Yet in America, as well as many of the developed countries of the world, the incidence of such strokes is declining, while in emerging economies, the opposite is true. In fact, the number of total deaths from ischemic stroke (IS) due to use of tobacco products is higher in China, India, and Russia than all of the world’s other countries combined, a new study finds. “In China, Russia, and India, even modest reductions in the number of current smokers could see millions of lives saved due to prevention of IS alone," wrote the authors in their report published online in Global Heart.

Dr. Derrick Bennett, University of Oxford, and his colleagues examined and analyzed the results in a global burden of disease study. In both 1990 and 2010, the top ranked countries for IS deaths attributed to tobacco consumption were China, Russia, and India. In 2010, there were about 11,569,000 IS events (63 percent in low- and middle-income countries or LMIC), approximately 2,835,000 deaths from IS (57 percent in LMIC), and approximately 39,389,000 disability-adjusted life year (DALY), a term for a year lost due to disability due to IS (64 percent in LMIC).

Between the years 1990 and 2010, a significant increase occurred in the number of strokes, including a 37 percent increase in the total number of people with an IS event, a 21 percent increase in deaths from IS, and an 18 percent increase in DALY lost due to IS. Yet, compared across ages, the incidence of IS, deaths, and DALY lost in high-income countries declined while in LMIC an increase occurred. In particular, China, Russia, and India were ranked highest in both 1990 and 2010 for IS deaths caused by tobacco consumption.

The underlying condition for the obstruction causing ischemic strokes is the development of fatty deposits lining the walls of the arteries. This process, which is known as atherosclerosis and commonly referred to as “hardening of the arteries,” is more common in men as well as people with a family history of cardiovascular disease. Risk factors include cigarette smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and diabetes mellitus.

“In recent decades, there have been significant reductions in smoking in [high income countries or] HIC (such as the United States) due to political interventions (such as smoke-free policies, higher taxes, and/or higher prices), smoking cessation programs, and clinical guidelines,” wrote the authors in the conclusion to their study. They suggest that several of these approaches, which have been successfully implemented in HIC at the beginning of the current century, might be adopted for use in LMIC settings.

Source: Bennett DA, Krishnamurthi RV, Barker-Collo S, et al. The Global Burden of Ischemic Stroke Findings of the GBD 2010 Study. Global Heart. 2014.