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. 2023 Feb;30(2):353-361.
doi: 10.1111/ene.15605. Epub 2022 Nov 5.

Ischaemic stroke in South Asians: The BRAINS study

Taylor Aurelius  1 , Ankita Maheshwari  2 , Gie Ken-Dror  1 , Sapna D Sharma  1 , Sageet Amlani  3 , Gunaratnam Gunathilagan  4 , David L Cohen  5 , Chakravarthi Rajkumar  6 , Stuart Maguire  7 , Sissi Ispoglou  8 , Ibrahim Balogun  9 , Anthea Parry  10 , Lakshmanan Sekaran  11 , Hafiz Syed  12 , Enas Lawrence  13 , Ravneeta Singh  14 , Ahamad Hassan  15 , Chris Wharton  16 , Khalid Javaid  17 , Neetish Goorah  18 , Peter Carr  19 , Eman Abdus Sami  20 , Shri Ram Sharma  21 , Padmavathy N Sylaja  22 , Kameshwar Prasad  2 , Pankaj Sharma  1   23   24 ; BRAINS collaborators
Affiliations

Ischaemic stroke in South Asians: The BRAINS study

Taylor Aurelius et al. Eur J Neurol. 2023 Feb.

Abstract

Background and purpose: Studies on stroke in South Asian populations are sparse. The aim of this study was to compare differences in age of onset of ischaemic stroke in South Asian patients living in the United Kingdom and South Asian patients living in India versus White British stroke patients.

Methods: We studied the UK and Indian arms of the ongoing BRAINS study, an international prospective hospital-based study of South Asian stroke patients. The BRAINS study includes 4038 South Asian and White British patients with first-ever ischaemic stroke, recruited from sites in the United Kingdom and India.

Results: Of the included patients, 1126 were South Asians living in India (ISA), while 1176 were British South Asian (BSA) and 1736 were White British (WB) UK residents. Patients in the ISA and BSA groups experienced stroke 19.5 years and 7.2 years earlier than their WB counterparts, respectively (mean [interquartile range] age: BSA 64.3 [22] years vs. ISA 52.0 [18] years vs. WB 71.5 [19] years; p < 0.001). Patients in the BSA group had higher rates of hypertension, diabetes mellitus and hypercholesterolaemia than those in the ISA and WB groups. After adjustment for traditional stroke risk factors, an earlier age of stroke onset of 18.9 years (p < 0.001) and 8.9 years (p < 0.001) was still observed in the ISA and BSA groups, respectively. In multivariable stepwise linear regression analysis, ethnicity accounted for 24.7% of the variance in early age onset.

Conclusion: Patients in the BSA and ISA groups experienced ischaemic stroke approximately 9 and 19 years earlier, respectively, than their WB counterparts. Ethnicity is an independent predictor of early age of stroke onset. Our study has considerable implications for public health policymakers in countries with sizable South Asian populations.

Keywords: age onset; ethnicity; health inequality; stroke.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

FIGURE 1
FIGURE 1
Average age of onset (years) among stroke subtypes, stratified by ethnicity. Error bars denote standard deviation. Average age for all stroke refers to all stroke subtypes combined. Stroke subtype was defined using the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification system. BSA, British South Asians living in the United Kingdom; ISA, South Asians living in India; WB, White British individuals living in the United Kingdom
See this image and copyright information in PMC

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