Stroke is the leading cause of sustained neurological disability worldwide and, after coronary heart disease and cancer, the third leading cause of death globally.The burden of this condition is rising, especially in low- and middle-income countries, where there is typically limited capacity to deal with the personal, social and economic impact of these increases. The projected increase in stroke and CHD is expected to be much greater in South Asia than in any other region worldwide, adding to the continuing burden of infectious, nutritional, and perinatal disorders, resulting in a “double-burden” of diseases in this region.Projections from the National Health Survey of Pakistan estimate that at least 500,000 people suffer from CHD and stroke each year in Pakistan alone. There is limited direct evidence, however, about the determinants of stroke from people living in South Asia and, in particular, from Pakistan. Such evidence could, however, contribute importantly to scientific understanding and the development of locally appropriate strategies to prevent and control stroke and related vascular conditions.

The Risk Assessment of Cerebrovascular Events study (RACE)is an epidemiological resource to enable reliable study of genetic, lifestyle and biomarker determinants of stroke and its subtypes in South Asia. Until the initiation of RACE, fewer than 300 patients and a similar number of controls had been assessed in all available epidemiological studies of stroke in Pakistan, a country with a population of over 180 million. By September 2011, RACE had enrolled >5,000 imaging confirmed stroke cases and >5000 controlsfrom urban Pakistan. For each participant, biological samplesincluding DNA, serum, plasma and whole blood have been obtained and information has been collected on >20 soluble biomarker levels, genome-wide association data, CT/MR images and lifestyle factors using a 600-item validated questionnaire.

During its next stage, the study aims toexpand recruitment to achieve a total of about 20,000 cases (and equivalent number of controls), of whom there will be an anticipated 5,000 cases with hemorrhagic stroke, and 3000 cases each with cardio-embolic, large vessel and small vessel disease.