Introduction
Stroke remains a major public health challenge both globally and in the United States. According to the Centers for Disease Control and Prevention (CDC), “Stroke is a leading cause of death in the United States and is a major cause of serious disability for adults” (1). The World Health Organisation (WHO) similarly reports that “Stroke was the third leading cause of death and disability globally” in 2021 (2).
Strokes are increasingly affecting South Asian communities, including Sikhs. South Asians have higher mortality rates from ASCVD (Atherosclerotic Cardiovascular Disease), caused by buildup of fatty plaques inside arteries that can lead to heart attack, stroke (3). Almost three-quarters of South Asians were identified as having high lifetime predicted ASCVD risk (4). The increased risk is largely explained by “the increased prevalence of known risk factors, especially those related to insulin resistance” (3). In relation to stroke, the CDC states that conditions such as “obesity, high blood pressure, high cholesterol, and diabetes” can raise the risk for stroke (1). The National Institutes of Health (NIH) notes that ischemic and hemorrhagic strokes share risk factors “such as high blood pressure, diabetes, and high blood cholesterol” (5). Migration may further increase cardiometabolic risk by influencing adiposity and type 2 diabetes (6). Because diabetes, hypertension, high cholesterol, obesity, and heart disease are established risk factors for stroke (1, 5), these conditions may contribute to the increased ischemic stroke risk.
Understanding the Difference- Heart Attack and Stroke
When a person experiences chest pain, pressure, shortness of breath, or other symptoms that may suggest a heart attack, one of the first tests performed is an electrocardiogram (EKG or ECG). The EKG can identify changes in the heart's electrical activity, including ST-segment elevation, which may indicate a serious type of heart attack known as a STEMI. Additional blood tests and imaging are often used to confirm the diagnosis. If a heart attack is suspected, a coronary angiogram is performed, which allows cardiologists to identify which coronary artery is blocked and determine the severity and location of the blockage. Depending on the findings, treatment may involve balloon angioplasty and stent placement to restore blood flow. In cases involving multiple severe blockages or complex disease, open-heart bypass surgery may be recommended. The goal is to restore blood flow as quickly as possible and minimize damage to the heart muscle.
Stroke is different from a heart attack because it affects the brain rather than the heart. A stroke is a medical emergency that occurs when blood flow to the brain is interrupted, which can lead to brain cell death and serious complications (2). When blood supply to part of the brain is blocked or reduced, brain tissue is deprived of oxygen and nutrients, and brain cells begin to die within minutes (5).
Ischemic stroke occurs when a blood clot blocks a blood vessel in the brain, leading to loss of blood flow (2). Hemorrhagic stroke occurs when a blood vessel in the brain ruptures and causes bleeding (2). Many common medical conditions can increase the chances of having a stroke, including high blood pressure, high cholesterol, heart disease, diabetes, and obesity (1). A transient ischemic attack (TIA), also known as a mini-stroke, involves a short period of symptoms similar to those of a stroke caused by a brief blockage of blood flow to the brain (1, 2). After a TIA, the chances of having another stroke are higher (1).
Rapid recognition of stroke symptoms is critical because early treatment substantially improves survival and neurological recovery.
B.E. F.A.S.T. can help stroke patients get the treatments they need. Stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms (1).
B — Balance loss: ask whether the person feels off-balance or dizzy.
E — Eye or vision changes: ask whether the person has trouble seeing normally.
F — Face: ask the person to smile and check whether one side of the face droops.
A — Arms: ask the person to raise both arms and check whether one arm drifts downward.
S — Speech: ask the person to repeat a simple phrase and check whether speech is slurred or strange.
T — Time: if any of these signs are present, call 9-1-1 right away.
When someone experiences stroke symptoms, a CT scan is often performed immediately to determine whether the stroke is ischemic (caused by a blocked artery) or hemorrhagic (caused by bleeding in or around the brain). For certain ischemic strokes, patients may receive tissue plasminogen activator (tPA), a clot-dissolving medication that must be administered within a specific time window after symptom onset and only if they meet eligibility criteria. Some patients may also undergo a mechanical thrombectomy, a procedure that removes large clots from the brain's arteries. If a hemorrhagic stroke is present, neurosurgeons may perform procedures to relieve pressure, repair damaged blood vessels, or control the bleeding.
Recovery from stroke can be lengthy and challenging. Depending on the severity of the brain injury, individuals may experience paralysis, speech difficulties, memory problems, emotional changes, and challenges performing everyday activities. Many require months or years of rehabilitation, including physical, occupational, and speech therapy.
Identifying and treating stroke risk factors can help lower the chances of stroke (1,5). Timely intervention and prevention efforts can reduce stroke-related death and disability (2).
The Rising Burden of Stroke Among South Asians, including Sikhs
Heart disease and stroke rarely result from a single cause. Instead, they are usually caused by a combination of genetic, lifestyle, and environmental factors. High blood pressure, diabetes, high cholesterol, obesity, smoking, physical inactivity, poor diet, chronic stress, and environmental exposures such as air pollution all contribute to cardiovascular risk. Delayed preventive care and healthcare access barriers, including language differences, cultural factors, long work hours, and limited awareness of preventive screening, may further increase risk.
South Asian migrants living in several countries have higher death rates from coronary heart disease (CHD) at younger ages than the local population (7). They also tend to have a greater burden of cardiovascular risk factors before the age of 60 (7). South Asians may be at increased risk for cardiovascular disease (CVD), largely because of a higher prevalence of metabolic syndrome (even at lower BMI levels), insulin resistance, and atherogenic dyslipidemia. Atherogenic dyslipidemia is characterized by elevated triglycerides, reduced HDL-C levels, an increased number of LDL particles, a greater proportion of small, dense LDL particles, and elevated lipoprotein(a), all of which may contribute to increased CVD risk (8).
More recently, community-based outreach efforts have helped create broader conversations around health within Sikh community across the United States. Through on-the-ground awareness initiatives, educational events, health fairs, and community engagement activities, Sikhs in Clinical Research (SICR) has also begun conducting health surveys to better understand disease patterns and healthcare concerns affecting Sikh populations. These initiatives have provided important insight into the growing burden of cardiometabolic diseases within the community and the significant impact these conditions have on individuals, families, and entire communities (9).
Disease Burden in the Sikh Community
Cardiovascular disease emerged as the most commonly reported health concern among surveyed individuals. Reported conditions included hypertension, heart attack, stroke, chest pain, and other cardiovascular complications, with hypertension being the most frequently reported condition. SICR survey findings showed that 241 of 400 individuals reported having a cardiovascular-related condition (9).
These findings are consistent with broader research demonstrating that South Asian populations experience a disproportionately high burden of cardiovascular disease and related risk factors.
Endocrinological conditions also appeared highly prevalent within the surveyed population, affecting 140 of 400 individuals. Diabetes and cholesterol disorders accounted for the majority of these conditions, with Type 2 diabetes appearing substantially more common than Type 1 diabetes. In addition to diabetes, thyroid disorders and vitamin D deficiency were also reported among surveyed participants (9).
Community Voices: Stories about Stroke
One cardiac nurse in our network shared the story of a community member who suffered a severe hemorrhagic stroke involving brain bleeding. The individual required brain surgery and spent nearly three months in the intensive care unit. Following the stroke, they lost many of their abilities, including walking and speaking. Recovery was slow and required years of rehabilitation. It took almost three years for them to regain much of their independence.
Their experience highlights how devastating stroke can be and how recovery often extends far beyond the initial hospitalization. Long-term management frequently includes controlling blood pressure, managing cholesterol, attending regular medical follow-up appointments, and taking medications prescribed by healthcare providers to reduce the risk of future cardiovascular events. She mentioned that serious situations could have been prevented or at least delayed with earlier awareness and intervention (10).
Many families in our community have their own stories about stroke. One of my aunts died suddenly from a stroke, leaving the family shocked and grieving. Sadly, stroke can occur without warning and can be fatal.
My father-in-law recently suffered an ischemic stroke, although we considered him relatively healthy beforehand. At the hospital, doctors confirmed that a clot had blocked blood flow to part of his brain. The first few days were frightening. He struggled with movement and became frustrated when simple words would not come easily. Everyday activities such as buttoning a shirt, holding a spoon, or walking to the bathroom suddenly required assistance.
After leaving the hospital, he began speech therapy that helped improve his communication. One of the most difficult lessons was realizing that recovery would not happen overnight. Even months later, he is not fully recovered.
Over time, however, he regained independence; the experience also changed our perspective on health. How can we do better? He has always been committed to staying physically active through daily walks. Do we add to the routine: monitoring his blood pressure, attending regular medical appointments, and maintaining a healthy diet? He has a strong will power that helped him fight a stroke, and we appreciate his small victories during recovery.
Why Is Stroke So Relevant in the Sikh Community?
Stroke is highly relevant because many of the major stroke risk factors are already disproportionately prevalent among Sikh and South Asian populations. Through our outreach efforts, we frequently encounter individuals living with high blood pressure, Type 2 diabetes, abdominal obesity, high cholesterol, and cardiovascular disease.
Many people may not recognize early warning signs or may delay seeking care until conditions become severe. Language differences, long work hours, immigration, limited preventive screenings, and cultural normalization of ignoring symptoms can further contribute to these challenges. A physician in the Sikh community recently expressed concerns about an increasing number of cardiovascular-related deaths occurring at younger ages.
Preventive Gaps and The Importance of Early Detection
The World Health Organization (WHO) and the American Diabetes Association (ADA) have recommended lower BMI cut points for overweight and obesity in Asian populations (11). South Asians worldwide have a high prevalence of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), which often occur at younger ages and are associated with premature mortality (12). These findings suggest that cardiometabolic risk in South Asians may develop at lower BMI levels than would be expected using conventional BMI standards (11,12).
Stroke prevention includes regular physical activity, healthy dietary choices, avoiding tobacco use, maintaining a healthy weight, and managing medical conditions such as high blood pressure, high cholesterol, diabetes, and heart disease (1). Early recognition of stroke symptoms, timely medical care, and preventive interventions can reduce stroke-related death and disability (2).
One physician in the Sikh community emphasizes coronary artery calcium (CAC) scoring, a simple, non-invasive CT scan that measures calcium buildup in the coronary arteries. This scan can help assess future heart disease risk and may be particularly useful for adults with risk factors such as a family history of heart disease, high blood pressure, high cholesterol, diabetes, obesity, smoking history, or elevated inflammatory markers.
Individuals interested in this screening should discuss with their healthcare provider whether it is appropriate for them. Early detection of cardiovascular risk factors provides opportunities for intervention before a heart attack or stroke occurs.
Call to action
As the Asian American population continues to grow, it is essential to better understand and address cardiovascular disease (CVD) disparities among Asian American subgroups (13). Future community-based participatory research should focus on stroke incidence, healthcare access, and preventive screening within the Sikh community.
Reducing the burden of stroke and cardiovascular disease requires earlier detection, stronger prevention, and improved access to care. Building trust between healthcare systems and communities, and ensuring culturally and linguistically appropriate approaches, are key to closing existing gaps.
Greater representation in clinical research is critical to developing prevention strategies that reflect the needs of diverse populations. Collaborations with community organizations, faith-based groups, and trusted community leaders can further strengthen education, outreach, and engagement.
While genetics may contribute to risk, many cardiovascular and stroke risk factors are modifiable. Expanding awareness and improving access to routine screening can help prevent disease before it progresses and improve long-term outcomes for future generations.
References
- Centers for Disease Control and Prevention. (2024). Stroke signs and symptoms. https://www.cdc.gov/stroke/signs-symptoms/index.html
- World Health Organization. (2024). Stroke. https://www.who.int/news-room/fact-sheets/detail/stroke
- Volgman, A. S., Palaniappan, L. S., Aggarwal, N. T., Gupta, M., Khandelwal, A., Krishnan, A. V., Lichtman, J. H., Mehta, L. S., Patel, H. N., Shah, K. S., Shah, S. H., Watson, K. E., & Wong, N. D. (2018). Atherosclerotic cardiovascular disease in South Asians in the United States: Epidemiology, risk factors, and treatments. Circulation, 138(1), e1–e34. https://doi.org/10.1161/CIR.0000000000000580
- Kandula, N. R., Kanaya, A. M., Liu, K., Lee, J. Y., Herrington, D., & Hulley, S. B. (2014). Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians: Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Journal of the American Heart Association, 3(5), e001117. https://doi.org/10.1161/JAHA.114.001117
- National Institute of Neurological Disorders and Stroke. (n.d.). Stroke. National Institutes of Health. https://www.ninds.nih.gov/health-information/disorders/stroke
- Misra, A., & Ganda, O. P. (2007). Migration and its impact on adiposity and type 2 diabetes. Nutrition, 23(9), 696–708. https://doi.org/10.1016/j.nut.2007.06.008
- Joshi, P., Islam, S., Pais, P., Reddy, S., Dorairaj, P., Kazmi, K., Pandey, M. R., Haque, S., Mendis, S., Rangarajan, S., Yusuf, S., & INTERHEART Investigators. (2007). Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA, 297(3), 286–294. https://doi.org/10.1001/jama.297.3.286
- Gupta, M., Singh, N., & Verma, S. (2006). South Asians and cardiovascular risk: What clinicians should know. Circulation, 113(25), e924–e929. https://doi.org/10.1161/CIRCULATIONAHA.105.583815
- Grewal, E. (2025). Understanding the health needs of the Sikh community in the U.S. Sikhs in Clinical Research. Understanding the Health Needs of the Sikh Community in the U.S..
- Kaur, N. (2026). From the frontlines of cardiac care: What I see every day and why it matters. Sikhs in Clinical Research. https://sikhsinclinicalresearch.org/blog/from-the-frontlines-of-cardiac-care-what-i-see-every-day-and-why-it-matters
- Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: Epidemiology, risk factors, and treatments. Circulation. 2018;138(1):e1–e34.https://www.ahajournals.org/doi/10.1161/cir.0000000000000580
- Gholap, N., Davies, M., Patel, K., Sattar, N., & Khunti, K. (2011). Type 2 diabetes and cardiovascular disease in South Asians. Primary Care Diabetes, 5(1), 45–56. https://doi.org/10.1016/j.pcd.2010.08.002
- Palaniappan, L. P., Araneta, M. R. G., Assimes, T. L., Barrett-Connor, E. L., Carnethon, M. R., Criqui, M. H., Fung, G. L., Narayan, K. M. V., Patel, H., Taylor-Piliae, R. E., Wilson, P. W. F., & Wong, N. D. (2010). Call to action: Cardiovascular disease in Asian Americans. Circulation, 122(12), 1242–1252.https://doi.org/10.1161/CIR.0b013e3181f22af4
