Stroke in South-Asian Populations: Unique Susceptibility, Risk Factors, and Treatment Considerations

South-Asians comprise one-quarter of the world’s population, yet account for 40% of global stroke deaths ¹ . They experience earlier stroke onset than whites, a 1.5-fold higher stroke mortality than Europeans, and a higher risk relative to other Asian populations. However, most studies aggregate South-Asians with other Asian populations or compare native South-Asians with other immigrant groups. This review synthesizes current evidence on the burden of stroke, epidemiology, risk factors, clinical presentation, subtypes, mechanisms, and treatment in South-Asians, with an emphasis on disparities compared to other ethnic groups. We discuss risk factors including distinct cardiometabolic profiles, genetic polymorphisms that affect homocysteine levels and drug metabolism, dietary patterns, and lifestyle factors. We review stroke subtypes in South-Asians and explore treatment and prevention strategies. Finally, we offer recommendations to target the multifactorial origins of elevated stroke burden in South-Asians, including improvements in screening, pharmacogenomic testing, and thresholds for intracranial vessel imaging. To address this disparity and reduce the high burden of stroke in these communities, it is important to develop tailored management strategies, increase clinical trial representation, and establish South-Asian stroke registries.