Ras Al Khaimah Acute Stroke Study Reveals Younger Onset and High Comorbidity Burden

The Growing Stroke Challenge in the UAE

Stroke remains one of the leading causes of death and disability worldwide, and the United Arab Emirates (UAE) is no exception. In a country with a rapidly aging population and high prevalence of lifestyle-related risk factors, acute stroke cases are surging, particularly among younger individuals compared to Western nations. Recent research from Ras Al Khaimah highlights this alarming trend, providing critical insights into local patterns that can inform prevention strategies and healthcare policy.

The UAE's unique demographic makeup—over 88% expatriates from diverse backgrounds—adds complexity to stroke epidemiology. Traditional risk factors like hypertension (high blood pressure, or HTN) and diabetes mellitus (DM) are rampant due to sedentary lifestyles, unhealthy diets, and genetic predispositions prevalent in South Asian and Middle Eastern populations. This study from Ras Al Khaimah not only fills a regional data gap but also underscores the pivotal role of local universities like Ras Al Khaimah Medical and Health Sciences University (RAKMHSU) in advancing public health research.

Overview of the Ras Al Khaimah Acute Stroke Study

Conducted at Ibrahim Bin Hamad Obaidullah Hospital (IBHOH), a World Stroke Organization (WSO) Diamond-certified stroke center and teaching affiliate of RAKMHSU, this retrospective hospital-based study analyzed 837 patients admitted with acute stroke from January 1, 2020, to December 31, 2024. Led by medical student Mohammed AlOmar and colleagues including faculty like Prof. Omer Eladil, the research was presented at the 6th Dubai International Neurology Congress (DINC 2026), marking the first large-scale analysis of stroke patterns in the Northern Emirates.

The study's objective was to delineate demographic profiles, stroke subtypes—ischaemic (blockage of blood flow) versus haemorrhagic (bleeding in the brain)—and comorbidity burdens, using hospital electronic records. Ethical approval came from RAKMHSU's Institutional Review Board, ensuring patient data anonymity. Statistical tools like chi-square tests and logistic regression identified associations, revealing patterns with significant public health implications.

Patient Demographics: Younger Onset and Male Predominance

The cohort's mean age was 55.7 years (standard deviation ±14.3, range 20–109), strikingly younger than the global average of 70+ years in Western populations. Nearly half the cases (about 47%) occurred between 45 and 65 years, with one in four under 45—highlighting a shift toward early-onset strokes. Men comprised 76.2% (638 patients), experiencing onset at a mean age of 54 years versus 61.2 for women (199 patients), a male-to-female ratio of roughly 3:1.

This male skew aligns with UAE trends where expatriate laborers, predominantly male from South Asia, face high stress and physical demands. While nationality data wasn't detailed, Ras Al Khaimah's diverse population (Emiratis ~15%, expatriates majority) likely influences these figures, emphasizing tailored screening for at-risk groups.

Stroke Subtypes: Dominance of Ischaemic Events

Ischaemic strokes dominated at 81% (678 cases), consistent with global patterns but with notable local nuances. Haemorrhagic strokes accounted for 19% (159 cases), disproportionately higher in younger patients (≤45 years: 25.6% vs. ≥65 years: 17.4%; p=0.037). This age-related shift suggests hypertension control failures in youth, as uncontrolled high blood pressure often triggers vessel rupture.

In the UAE context, ischaemic predominance ties to metabolic syndrome—clustered HTN, DM, dyslipidemia (high cholesterol), and obesity—prevalent due to rapid urbanization and dietary shifts toward processed foods.

Comorbidity Landscape: HTN and DM Lead the Pack

Hypertension afflicted 75.2% (629 patients), diabetes 49.5% (414), atrial fibrillation (irregular heartbeat) 6.3% (53), prior stroke 15.4% (129), and smoking 24.9% among documented cases (170/682). These rates exceed global averages, mirroring Gulf Cooperation Council (GCC) trends where DM prevalence hits 20-25% nationally, driven by consanguinity, genetics, and lifestyle.

• HTN as modifiable kingpin: Often asymptomatic, yet primary ischaemic driver via atherosclerosis (plaque buildup).
• DM's vascular toll: Accelerates small vessel disease, doubling stroke risk.
• Smoking synergy: Exacerbates clotting in men.

Sex Disparities in Risk Profiles

Women showed higher HTN (82.8% vs. 72.9%; p=0.005), DM (56.8% vs. 47.2%; p=0.0018), and AF (10.1% vs. 5.2%; p=0.014), possibly linked to postmenopausal changes and lower physical activity. Men dominated smoking (31.7% vs. 1.9%; p<0.001) but similar stroke subtypes (ischaemic ~81-83%).

These differences call for gender-specific interventions: stress management for women, tobacco cessation for men. RAKMHSU's integration of such insights into curricula equips future physicians for equitable care.

Age Variations and Recurrent Stroke Risks

Older patients (≥65) had more ischaemic strokes (82.6% vs. 74.4% in ≤45), prior strokes more frequent with age (OR=1.03/year; p<0.001). DM (OR=1.69; p=0.015) independently predicted recurrence, alongside HTN (p=0.015). Multivariate analysis (McFadden's R²=0.051) confirmed these links, stressing secondary prevention like statins and anticoagulants.

Implications for UAE Public Health

This RAKMHSU-led study spotlights actionable gaps: younger strokes demand workplace screenings, especially for expatriates. IBHOH's WSO Diamond status exemplifies UAE's stroke-ready infrastructure, but Northern Emirates lag behind Dubai/Abu Dhabi in thrombolysis access (clot-busting drugs within 4.5 hours).Gulf News coverage urges nationwide FAST campaign (Face drooping, Arm weakness, Speech difficulty, Time to call).

Policy-wise, UAE Vision 2031 targets NCDs (non-communicable diseases); integrating study data could enhance national registries.

RAKMHSU's Role in Translational Research

RAKMHSU, UAE's first integrated medical university, bridges academia and clinic via IBHOH affiliation. Student-led projects like this foster research skills, with presentations at DINC showcasing Northern Emirates' contributions. Future collaborations could explore genomics or AI for risk prediction, aligning with UAE's AI Strategy 2031.

Photo by 86 media on Unsplash

Prevention Strategies and Future Outlook

Primary prevention: Lifestyle mods—DASH diet (Dietary Approaches to Stop Hypertension), 150 min/week exercise, BP <130/80 mmHg, HbA1c <7%. Secondary: Aspirin for high-risk, carotid endarterectomy. RAKMHSU advocates community education, leveraging its public health programs.

Prospects: Prospective multicenter studies including nationalities, long-term mRS (modified Rankin Scale for disability). With UAE's youthful demographic, averting 80% strokes via risk control is feasible.Full study preprint

• Mediterranean diet adoption
• Digital BP monitoring apps
• Youth awareness campaigns