Fathimanoud, Correspondent, India Pharma Outlook
A stroke is a critical medical emergency where every minute matters. When blood supply to the brain is interrupted, millions of brain cells begin to die each minute, drastically increasing the risk of long-term disability or life-threatening complications.
In such emergencies, immediate intervention by those present serves as the first line of defense before emergency services arrive.
World Stroke Day takes place every year on 29 October to bring global attention to stroke, its prevention, treatment and long-term impact.
The World Stroke Organization established the day in 2006, following the development of the World Stroke Proclamation, and has since used it as a focal point for global awareness and action.
In India, the stakes run especially high. Stroke incidence continues to climb, cases strike at younger ages than in many high-income countries, and a large share of survivors face permanent disability that reshapes entire families.
Amid the familiar risk factors of high blood pressure and diabetes, one driver remains chronically under-addressed: tobacco dependence. This World Stroke Day, the message must be clear that India cannot bend its rising stroke curve until it confronts tobacco dependence with the same urgency it applies to emergency care.
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A stroke occurs when blood flow to part of the brain becomes blocked or when a blood vessel in the brain bursts. An ischaemic stroke occurs when a clot or other blockage prevents blood from reaching brain tissue, while a haemorrhagic stroke occurs when a blood vessel ruptures and causes bleeding in or around the brain.
In either case, the affected brain cells lose their supply of oxygen and nutrients, which can cause damage within minutes and lead to problems with movement, speech, vision, memory or other functions depending on the area affected.
Speed decides everything. Every minute without restored blood flow destroys roughly two million neurons. The lasting consequences range from paralysis and speech loss to cognitive decline and personality change.
World Stroke Day exists precisely to drive home this dual reality that stroke can strike anyone, yet timely recognition and action can dramatically improve outcomes. Public understanding of both the danger and the possibility of better recovery remains essential.
Stroke ranks as one of the biggest health challenges on the planet. It is the second leading cause of death among non-communicable diseases and the third leading cause of death and disability combined worldwide.
More than 12 million people have a stroke every year, and the number of strokes, stroke deaths and people living with stroke has risen sharply since 1990. The World Stroke Organization estimates that incident strokes have increased by about 70% and stroke deaths by about 44% between 1990 and 2021.
India sits among the countries hardest hit. Stroke incidence here is estimated at 108–172 cases per 100,000 people each year, with a one-month case fatality rate of 18–42%. Stroke also affects people at younger ages in India than in many high-income countries, and a large share of survivors are left with lasting disability that changes daily life for the whole family. Many of the underlying risk factors are modifiable, and one of the most important and most overlooked is tobacco use in all its forms.
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The impact of stroke goes well beyond the hospital. The global cost of stroke is estimated at 0.66% of the world’s GDP.
These costs include emergency care, hospital stay, medicines, rehabilitation and long-term care, as well as income lost when people can no longer work. For Indian families, the effects prove wide-ranging and often devastating:
Delayed care and uncontrolled risk factors such as high blood pressure and tobacco use drive most of this avoidable cost. Early recognition, fast treatment and aggressive prevention remain the most effective ways to reduce both the human and the economic burden of stroke.
India continues to face a significant burden of stroke and cardiovascular disease, making the prevention of modifiable risk factors a public-health priority. Tobacco use remains a major preventable contributor to this burden.
On World Stroke Day, experts are calling for a stronger, more comprehensive approach to tobacco control that moves beyond awareness campaigns to address nicotine dependence, improve access to cessation support and strengthen prevention efforts.
A 2024 analysis of Global Burden of Disease data estimated that tobacco use contributed to 12% of stroke deaths in India, while high systolic blood pressure accounted for 56%. These findings highlight the need to address tobacco use alongside other major risk factors as part of a broader strategy to prevent stroke and cardiovascular disease.
The scale of the problem is staggering. The World Health Organization estimates that tobacco use accounts for nearly 1.35 million deaths annually in India. The country’s tobacco burden extends far beyond cigarettes to bidis and smokeless products such as khaini, gutkha and zarda. This diversity calls for prevention and cessation strategies that reflect different patterns of tobacco use and make quitting support accessible to people across communities.
Simple “quit” messaging repeatedly fails because nicotine dependence is powerful. Nicotine is highly addictive, while the combustion of tobacco releases toxic chemicals associated with serious cardiovascular harm.
Tobacco dependence therefore requires a combination of prevention, effective cessation support, public education and continued scientific research to inform public health decisions.
Dr. Yashpal Singh Bundela, Director of Neurosurgery and Neurosciences at Medanta Super Speciality Hospital, Noida, put the challenge bluntly: “We cannot keep telling people to quit and assume the problem is solved. Nicotine dependence can make quitting difficult, even when people understand the health risks. With the burden of tobacco-related diseases continuing to pose a serious public-health challenge, we need to act now. Helping people stop smoking must remain the priority, supported by practical, sustained cessation services and access to clinically established aids such as nicotine replacement therapy (NRT). Change will not be easy, but we must start somewhere. Moving beyond awareness to accessible, evidence-based support is an essential step towards reducing tobacco use and preventing related diseases.”
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International experience can offer useful lessons, provided India interprets the data carefully. A nationally representative Japanese study published in 2026 found that cigarette use among people aged 15–64 declined from 20.7% in 2017 to 12.3% in 2025, while heated tobacco use increased from 5.3% to 11.7%. Overall tobacco-product use declined more modestly, while dual use increased.
These findings describe changing patterns of tobacco use but do not establish that the rise in heated tobacco use caused cigarette smoking to decline or reduced long-term cardiovascular and stroke risks.
They underline the importance of examining international experiences carefully and evaluating their public-health implications in the Indian context rather than assuming any new product automatically delivers net benefit.
Dr Vikas Mittal, Director, Department of Respiratory Medicine, C K Birla Hospital, Punjabi Bagh, reinforced the need for open, evidence-driven thinking: “Improving public health requires us to look beyond conventional approaches to tobacco control and learn from the experiences of countries that have made progress in reducing tobacco use. India must have an open, evidence-based discussion on whether a complete ban on tobacco or newer, more effective approaches to prevention and cessation could deliver better public-health outcomes. The priority must be to reduce tobacco consumption, prevent young people from starting and make it easier for people who use tobacco to quit. Ultimately, our approach should be guided by one measure: what works best to protect public health and reduce the burden of tobacco-related diseases, including stroke and cardiovascular disease.”
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Reducing stroke and cardiovascular risk on World Stroke Day and every day requires sustained action on tobacco use alongside other established risk factors, particularly high blood pressure. India must:
Strengthening cessation support, preventing tobacco initiation and learning from evidence-based public-health interventions can help India build a more effective response to tobacco-related disease and protect the health of future generations.
Every minute still matters when a stroke strikes. World Stroke Day exists to remind us of that urgency and of the power of prevention. Reducing tobacco use is no longer optional if India wants to bend its stroke curve. Tobacco dependence remains one of the most powerful, yet most addressable, drivers of stroke deaths and disability in the country.
Editorial Note: This article is based on research and expert discussions for public awareness. It is not a substitute for medical advice. Seek emergency medical care immediately if stroke symptoms appear.
Fathimanoud is a Correspondent with experience covering the manufacturing and pharmaceutical sectors. She has written several articles on the pharma and manufacturing industries, with a particular focus on pharmaceutical developments and industry updates.
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