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Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Lifestyle Factors on the Risks of Ischemic and Hemorrhagic Stroke. Arch Intern Med. 2011;171(20):1811–1818. doi:10.1001/archinternmed.2011.443
Author Affiliations: First Affiliated Hospital of Medical School, Xi’an Jiaotong University, Xi’an, Shaanxi, China (Dr Zhang); Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana (Drs Zhang and Hu and Ms Wang); Department of Public Health, University of Helsinki, Helsinki, Finland (Dr Tuomilehto); South Ostrobothnia Central Hospital, Seinäjoki, Finland (Dr Tuomilehto); Department of Clinical Medicine and Prevention Medicine, Danube-University Krems, Krems, Austria (Dr Tuomilehto); Department of Chronic Diseases Prevention, National Institute for Health and Welfare, Helsinki (Drs Tuomilehto and Jousilahti); School of Human Ecology, Louisiana State University AgCenter, Baton Rouge (Ms Wang); Oulu City Hospital and Institute of Health Sciences, Oulu University, Oulu, Finland (Dr Antikainen); and Unit of General Practice (Geriatrics), Oulu (Dr Antikainen).
Background The joint effects of different lifestyle factors on stroke risk are still to some extent unclear, especially regarding hemorrhagic stroke.
Methods We prospectively investigated the association of different indicators of lifestyle (smoking, body mass index, physical activity, and vegetable and alcohol consumption) with total and type-specific stroke incidence among 36 686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline.
Results During a mean follow-up period of 13.7 years, 1478 people developed an incident stroke event (1167 ischemic and 311 hemorrhagic). The multivariate-adjusted (age, sex, education, family history of stroke, history of diabetes mellitus, systolic blood pressure, and serum total cholesterol level) hazard ratios associated with adherence to 0 to 1 (reference group), 2, 3, 4, and 5 healthy lifestyle indicators were 1, 0.66, 0.57, 0.51, and 0.33 (P < .001 for trend) for total stroke; 1, 0.67, 0.60, 0.50, and 0.30 (P < .001 for trend) for ischemic stroke; and 1, 0.63, 0.49, 0.49, and 0.40 (P < .001 for trend) for hemorrhagic stroke, respectively. These inverse associations were similar in both men and women. The partial population attributable risk percentages associated with adherence to 3, 4, and 5 healthy lifestyle indicators were 26.3%, 43.8%, and 54.6% for total stroke; 22.7%, 45.3%, and 59.7% for ischemic stroke; and 35.0%, 35.0%, and 36.1% for hemorrhagic stroke, respectively.
Conclusion Healthy lifestyle factors are associated with a lower risk of stroke, and there is a graded inverse association between the number of healthy lifestyle indicators and the risks of total, ischemic, and hemorrhagic stroke.
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