LAUSR

Ischemic stroke is a major public health problem and one of the leading causes of death worldwide.1 The risk of stroke increases with age.2 Although the majority of stroke patients are elderly, up to one third of first-ever strokes occur in patients <65 years, and 10-14% <55 years.2,3 Mortality rates in younger stroke patients are generally lower than older patients, but still much higher than in general population.4 Strokes have especially devastating implications if occur early in life given the long life expectancy during a demanding period of time in which they start to form families and make decisive career moves. Hence, stroke is a life-changing event that affect not only the person suffered, but also the entire family, as well as other caregivers. Furthermore, stroke survivors are at significantly higher risk of having recurrent vascular events.5 Therefore, early recognition and modification of underlying cardiovascular risk factors such as hypertension, diabetes, obesity, metabolic syndrome and smoking is crucial.6 We have recently highlighted the fundamental differences in the cardiovascular risk assessment of people from South Asia with particular focus on India, Pakistan and Bangladesh.7 These patients are often younger but have higher prevalence of pre-diabetes (insulin resistance), diabetes, abdominal obesity and an atherogenic type dyslipidemia (low HDL cholesterol and high triglycerides), despite lower total cholesterol and blood pressure (BP) levels compared with White Europeans. There are several risk stratification tools such as Framingham Risk Score, the European SCORE, and other North European risk tools such as NORRISK (Norwegian Risk) and FINRISK (Finland Cardiovascular Risk Study) to evaluate the risk of recurrent cerebrovascular event or myocardial infarction. However, most of these risk stratification tools are validated within the White European/American populations and may underestimate the risk of cardiovascular event in South Asian population.7 Overall, limited information exists on the prevalence, risk factors and the extent of subclinical cardiovascular disease in South Asian stroke patients, who are often younger than stroke patients of other regions.8 An important contribution to the current literature on the topic was the study of Sherin et al. on the prevalence and risk factors of stroke in Khyber-Pakhtunkhwa (KP), which was published in a recent edition of 1. Sahrai Saeed MD, PhD, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; 2. Marijana Tadic MD, PhD, University Hospital “Dr. Dragisa Misovic Dedinje” Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia; 3. Jukka Putaala MD, PhD. Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.