Preventing stroke during the Covid-19 pandemic

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TODAY is World Stroke Day. It is marked annually on this day with a mission to reduce the global burden of stroke through prevention, treatment and long-term care.

In 2018, stroke was the third leading cause of mortality in Malaysia, after heart disease and pneumonia. Yet, at least half of all strokes are potentially preventable with appropriate awareness and prevention.

About 1.7 million people in Malaysia have all three main non-communicable diseases (NCD): diabetes, hypertension and high blood cholesterol (dyslipidaemia).

High proportions of people with diabetes, hypertension or dyslipidaemia have uncontrolled glycated haemoglobin A1C (reflects blood glucose control over three months), blood pressure, or LDL-cholesterol (bad cholesterol) – also known as “ABC”.

The shortfall in achieving these ABC goals represents an avoidable burden of complications, including death. For example, it is estimated that suboptimal A1C control among diabetes patients represents about a 22% higher risk of heart attack, stroke and death. Inadequate blood pressure control may translate to around a 10% higher risk of diabetes-related death.

Suboptimal ABC control is expected to worsen during the current Covid-19 pandemic, which may disrupt clinic follow-ups or treatment adherence among patients with NCDs.

Covid-19 is a double blow for patients with NCDs. Data show that Covid-19-related deaths are disproportionately higher among them. Global evidence has also emerged on how the current pandemic disrupts essential public health services and expose patients to additional NCD risk factors such as mental health problems, overcrowding, unemployment and poor nutrition.

Globally, a decline in stroke admission is currently observed. Patients with mild symptoms may choose not to go to hospitals for evaluation due to the fear of exposure to Covid-19.

However, people experiencing sudden symptoms like balance difficulties, eyesight changes, facial weakness, arm weakness, and speech difficulties should immediately get help in a timely manner – remember “BE FAST” (Balance, Eyes, Face, Arm, Speech, Time). Time is critical as treatment within the “golden hour” of 60 minutes leads to better stroke outcomes.

The two take-home messages for all of us are:

1. Adhere to your prescribed treatment regimen and do not stop medications without doctor’s advice.

2. Seek medical attention immediately if symptoms of stroke develop, even during this current pandemic.

Remember, BE FAST.

DR WAN KIM SUI, PROF DR NORAN NAQIAH HAIRI & PROF DR MOY FOONG MING

Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya