Young adults in the UAE are typically experiencing brain injuries 20 years earlier than elsewhere in the world, with smoking and e-cigarette use among the factors that have elevated the risk.
Sedentary lifestyles, stress, poor air quality and genetic factors can all contribute to a greater stroke risk – a life-threatening condition that occurs when the brain is temporarily starved of blood flow due to a blocked artery or burst blood vessel.
Recorded strokes have increased by 70 per cent around the world since 1990, due to changes in lifestyle, environmental factors and also better diagnoses. Most stroke patients are aged about 65 and above. But in the UAE, the average age of those needing emergency care at Cleveland Clinic Abu Dhabi is 55 with a quarter of patients aged just 45.
To mark World Stroke Day on October 29, experts identified the high contribution of particulate matter air pollution in cases of brain bleeds as having a similar impact to long term smokers who also had a stroke. Dr Tommaso Tufo, a neurosurgeon at Fakeeh University Hospital said a complex interplay of lifestyle, genetic and environmental factors combine to expose more younger people in the UAE to strokes.
“We must consider here in the UAE the younger adults have an increasing prevalence of risk factors traditionally associated with older populations in other countries,” Dr Tufo told The National. “These are hypertension, diabetes, obesity, hyperlipidemia, which are more common in other countries in older people.
“Here in the UAE, they are associated with the young. We have to consider lifestyle as a risk factor, with processed food consumption, limited physical activity and elevated stress levels.
“Tobacco and nicotine use among younger adults is also correlated with an increasing risk of both ischemic and haemorrhagic stroke. In the UAE, there is a higher than average smoking rate in young adults, combined with the widespread use of e-cigarettes, which has amplified this risk.”
Ageing populations
In 2021, 11.9 million people worldwide were reported to have a new stroke according to analysis in the latest Global Burden of Disease, Injuries, and Risk Factors Study (GBD), and published in The Lancet Neurology. That number was up 70 per cent since 1990, partly due to ageing populations, with 7.3 million stroke related deaths, an increase of 44 per cent.
The five leading risk factors were high systolic blood pressure, particulate matter air pollution, smoking, high LDL cholesterol, and household air pollution. Ambient particulate matter air pollution was also identified in the study as a top risk factor for brain bleeding for the first time.
Researchers said poor air quality around the world contributed to 14 per cent of the death and disability caused by stroke, on a par with smoking. Dr Ahmed Ebied, a consultant neurologist at Medcare Hospital in Sharjah, said the convenience of modern life was also playing a role.
“Stroke prevalence is getting higher due to sedentary life and use of modern technology, with more food delivery and fast food options,” Dr Ebied said. “Exposure to excess heat can also be a contributing factor for dehydration in climates like we have in the Gulf.
“It's not about the heat itself that can affect the brain temperature, but also the brain metabolism. It's about the chronic exposure to high temperature that keeps our body in need for more hydration, specifically in elderly patients. Exposure to pollution is one of the factors that can contribute, but smoking is an important risk factor also.”
Risk factors
The current study provides the most up-to-date and comprehensive analysis of stroke burden and risk factor estimates globally between 1990 and 2021.
High-income North America and Australasia, and middle-income Latin America recorded the lowest stroke burden. Deaths from strokes were highest in North Macedonia (277 per 100,000) and lowest in Singapore (14 per 100,000).
The rates of incidence, prevalence and death from stroke were up to 10 times higher in low and middle income countries of East and Central Asia and sub-Saharan Africa, mainly due to poorly controlled high blood pressure, and rising levels of obesity and Type 2 diabetes in young adults, and also underfunded heath systems.
“Strokes generally happen to lower income workers and not so much the affluent people,” said Dr Derk Krieger, a neurologist at Fakeeh University Hospital. “A lot of my patients are Pakistani and Bangladeshi workers on the roads or in the construction business.
“They have very hard lives, and get strokes earlier than I would anticipate in Europe. When I do angiograms, we often see they have horrible vascular disease. They are young people, but they don't take care of themselves.”
Signs and symptoms
Symptoms can include a sudden numbness in the face or limbs, confusion, difficulty speaking or walking and dizziness. Immediate medical attention is required, to limit the impact and improve recovery.
Those over 40 should have regular blood pressure checks, a reliable indicator of potential signs of hypertension or heart disease which are contributing factors.
“We have better diagnostics now and better response systems,” said Dr Krieger. “People with stroke-related diseases come more often for early medical attention than they used to.
“Stroke numbers go up because there's more awareness in the population about them. I wouldn't say it has to do with stress or climate change, it’s not that simple.”
