Primary prevention of stroke by healthy lifestyle

Abstract

Background: The combination of healthy lifestyle factors is associated with lower risk of coronary heart disease, diabetes, and total cardiovascular disease. Little is known about the impact of multiple lifestyle factors on the risk of stroke.

Methods and results: We conducted a prospective cohort study among 43,685 men from the Health Professionals Follow-up Study and 71,243 women from the Nurses' Health Study. Diet and other lifestyle factors were updated from self-reported questionnaires. We defined a low-risk lifestyle as not smoking, a body mass index <25 kg/m(2), >or=30 min/d of moderate activity, modest alcohol consumption (men, 5 to 30 g/d; women, 5 to 15 g/d), and scoring within the top 40% of a healthy diet score. We documented 1559 strokes (853 ischemic, 278 hemorrhagic) among women and 994 strokes (600 ischemic, 161 hemorrhagic) among men during follow-up. Women with all 5 low-risk factors had a relative risk of 0.21 (95% confidence interval [CI], 0.12, 0.36) for total and 0.19 (95% CI, 0.09, 0.40) for ischemic stroke compared with women who had none of these factors. Among men, the relative risks were 0.31 (95% CI, 0.19, 0.53) for total and 0.20 (95% CI, 0.10, 0.42) for ischemic stroke for the same comparison. Among the women, 47% (95% CI, 18 to 69) of total and 54% (95% CI, 15 to 78%) of ischemic stroke cases were attributable to lack of adherence to a low-risk lifestyle; among the men, 35% (95% CI, 7 to 58) of total and 52% (95% CI, 19 to 75) of ischemic stroke may have been prevented.

Conclusions: A low-risk lifestyle that is associated with a reduced risk of multiple chronic diseases also may be beneficial in the prevention of stroke, especially ischemic stroke.

Figure 1

Relative risk and 95% confidence intervals for ischemic (A) and total (B) stroke by low-risk lifestyle score. Low-risk for each lifestyle factor was defined as not currently smoking, BMI<25 kg/m², exercise moderate/vigorous intensity for ≥30 minutes/day, diet in the top 40% of AHEI-based diet score distribution and average daily alcohol intake of 5–15 g/day among women and 5–30 g/day among men. Relative risks were adjusted for age (in months), calendar year, parental history of MI before 60, regular aspirin use and vitamin E supplementation and use of hormone therapy in women (current vs. not current).

Figure 1

Relative risk and 95% confidence intervals for ischemic (A) and total (B) stroke by low-risk lifestyle score. Low-risk for each lifestyle factor was defined as not currently smoking, BMI<25 kg/m², exercise moderate/vigorous intensity for ≥30 minutes/day, diet in the top 40% of AHEI-based diet score distribution and average daily alcohol intake of 5–15 g/day among women and 5–30 g/day among men. Relative risks were adjusted for age (in months), calendar year, parental history of MI before 60, regular aspirin use and vitamin E supplementation and use of hormone therapy in women (current vs. not current).