| Summary: | Appraisal of current literature reveals an increased burden of cerebrovascular disease amongst the migrant South Asian population living in the United Kingdom (UK) and a paucity of data concerning stroke pathophysiology among members of this ethnic group. To address these issues, a number of cross-sectional, retrospective, and prospective case control studies were performed, examining the stroke characteristics and its underlying vascular pathophysiology. The Digital Volume Pulse (DVP) analysis technique and laboratory-based studies were used to examine the structural and functional vessel wall abnormalities. In the initial registry-based studies, looking at a large stroke population, prevalence of diabetes was more common in South Asians. Ischaemic stroke mortality was associated with diabetes, which raises the question of how diabetes accelerates stroke in this population. In cross-sectional studies, we were able to test hypotheses related to structural and functional vessel wall characteristics, where South Asians demonstrated to have higher arterial stiffness and impaired endothelial function. Glycaemic status was independently associated with both impaired endothelial function and increased arterial stiffness amongst South Asian stroke survivors. Analysis of the endothelially-derived nitric oxide production cascade amongst South Asian stroke survivors, demonstrated a significantly lower endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) levels compared to European Caucasians. A separate sub study of this thesis validates the use of DVP analysis technique within the work of this thesis and its clinical utility for finer cardiovascular risk stratification. In conclusion, the epidemiological and pathophysiological findings of this thesis have important implications for UK South Asians and their high cerebrovascular disease burden. Observations within this thesis may aid targeted approaches for the alteration of cardiovascular risk profiles, which may aid the prevention of strokes in this high-risk community. The findings of this thesis would require validation in a large populationbased community studies.
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