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Stroke continues to be one of the world’s leading causes of death and disability. Every year, World Stroke Day on October 29 reminds us that time is brain: every minute matters. The faster a person receives treatment, the more brain cells are saved and the greater the chance of recovery. The good news is that stroke is now largely preventable and treatable when recognised early and managed quickly.
The 2024 American Heart Association (AHA) and American Stroke Association (ASA) guidelines bring new clarity to how we can prevent, detect, and treat stroke. These insights are transforming outcomes and must become common knowledge, not just medical expertise.

Prevention Begins Early
Stroke prevention starts decades before the event. Research now shows that stroke risk builds silently from the 30s onward. It is not enough to “check blood pressure and stop smoking.” Prevention must be a lifelong strategy.
1. Early screening: Regular checks of blood pressure, cholesterol, and blood sugar- starting in young adulthood- are crucial. Even mildly raised levels in the 30s and 40s can damage blood vessels and increase stroke risk later in life.
2. Lifestyle as medicine: A Mediterranean-style diet rich in vegetables, fruits, whole grains, nuts, and olive oil has proven benefits. The 2024 guidelines place strong emphasis on such a brain-healthy diet combined with adequate hydration.
3. Move more, sit less: New studies highlight that sedentary behaviour itself is harmful. Exercising daily but sitting for long periods still increases risk. Standing breaks, walking meetings, and active leisure are small but vital habits.
4. Life’s Essential 8: The AHA defines eight key behaviours and health measures for heart and brain health: balanced diet, physical activity, adequate sleep, avoiding tobacco, maintaining an ideal weight, and keeping blood pressure, blood sugar, and cholesterol within normal range. Practising these consistently can cut lifetime stroke risk by half.

Understanding Modern Risk Factors:
Science is now revealing more subtle and individual risk patterns beyond traditional causes like hypertension and diabetes.
Women’s health: Women face unique stroke risks linked to pregnancy-related hypertension, pre-eclampsia, early menopause, and long-term hormone therapy. Those with such histories have double the lifetime stroke risk. Gender specific counselling and preventive care are therefore essential.
Sleep and stress: Poor sleep quality, sleep apnoea, and chronic stress independently raise the risk of hypertension and stroke. Screening for sleep disorders and adopting relaxation practices such as yoga, meditation, and controlled breathing can protect brain health.
Metabolic and pharmacological advances: Modern medicines are helping in “precision prevention.” GLP-1 receptor agonists, used for diabetes and weight control, and PCSK9 inhibitors for cholesterol management, have been shown to reduce stroke risk in high-risk individuals. Treatment is now tailored, not generic.
Environmental and social influences: Noise pollution, air quality, access to safe spaces for physical activity, and education levels all influence cardiovascular and brain health. Recognising these social determinants of health allows governments and health systems to design inclusive, preventive programmes.
Recognising Stroke: Act F.A.S.T.
When a stroke occurs, recognition and response time decide the outcome. Public awareness remains the strongest defence.
The F.A.S.T. test helps everyone identify stroke symptoms quickly:
F – Face drooping: One side of the face feels weak or droops when smiling.
A – Arm weakness: The person cannot lift one arm, or it drifts downward.
S – Speech difficulty: Slurred or strange speech appears suddenly.
T – Time to call emergency services: Do not wait; call for help immediately.
However, some strokes show subtle signs, especially in younger adults and women. Sudden dizziness, imbalance, double vision, or loss of coordination can also signal a stroke. Recognising these early and reaching a hospital fast can make the difference between recovery and lifelong disability.

Transformations in Treatment
The greatest progress has come in hyperacute stroke care. Hospitals across the world and increasingly in India now use coordinated systems to diagnose and treat stroke within minutes.
Clot: busting drugs (thrombolysis): These drugs, given within 4-5 hours of symptom onset, can dissolve the blood clot that blocks blood flow to the brain. They remain the mainstay of acute treatment and are increasingly available in emergency departments and dedicated stroke units.
Mechanical thrombectomy: This catheter-based procedure physically removes the clot from large brain arteries. Recent research shows it can help selected patients even up to 24 hours after onset if brain imaging shows viable tissue. This technology has transformed survival and recovery rates in large vessel strokes.
Rehabilitation and recovery: Modern stroke care does not end with emergency treatment. Early physiotherapy, speech therapy, and occupational rehabilitation can restore independence and quality of life. The goal today is not just survival but complete recovery.

The Role of Public Health
Health systems play a crucial role in ensuring that prevention and treatment reach everyone. Public awareness campaigns, community-based screening for hypertension and diabetes, and linkage with emergency medical services can save thousands of lives.
India has made progress through the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and through expanded emergency care under the National Health Mission. Integrating these with telemedicine platforms like eSanjeevani and strengthening ambulance response under 108/112 services can make timely stroke care a reality even in rural areas.

A Call to Action
Stroke is no longer an inevitable part of ageing. It is largely preventable through smart choices and timely medical care.

The message on this World Stroke Day is clear:
Prevention starts early. Adopt healthy habits, manage blood pressure and sugar, and go for regular check-ups.
Recognition saves lives. Learn the F.A.S.T. signs and act immediately if symptoms appear.
Treatment changes outcomes. Clot-busting drugs and thrombectomy can restore life and independence, but only if accessed in time.
Small, everyday decisions-eating well, moving more, sleeping adequately, managing stress, and avoiding tobacco are daily acts of brain protection. Families should know the warning signs and keep emergency numbers handy.
As medical science advances and systems of care strengthen, stroke no longer has to mean permanent disability. With awareness, quick action, and equitable access, saving the brain is within everyone’s reach. Every minute matters: act fast, act smart, and give the brain a second chance.

Authored by: Prof. Dr Bindu Menon and Dr K. Madan Gopal
(Views expressed are personal)
Prof. Dr Bindu Menon is a Neurologist at Apollo Hospitals, Nellore; Board Member and Research Committee Co-Chair of the World Stroke Organisation (WSO); and Secretary General of the Indian Epilepsy Association.
Dr K. Madan Gopal is a Health Sector Expert and currently serves as Advisor, Public Health Administration Division , National Health Systems Resource Centre (NHSRC), New Delhi.