A new study of 36,686 Finnish men and women, published in the Archives of Internal Medicine, a journal of the American Medical Association, has found that 5 healthy lifestyle factors are associated with significantly reduced risk of stroke. And, the more of these healthy lifestyle factors one practices, the greater the reduction in stroke risk, the study found.
The five healthy lifestyle factors measured by the researchers include no smoking, body mass index of less than 25, moderate to high physical activity level, eating vegetables 3 or more times a week, and low alcohol consumption.
The study, by researchers from Pennington Biomedical Research Center, Baton Rouge, Louisiana, Xi’an Jiaotong University Medical School, Xi’an, Shaanxi, China, and the Department of Public Health, University of Helsinki, Helsinki, Finland, is published in the November 14, 2011 issue of the Archives of Internal Medicine.
The Study Methodology
The researchers analyzed data from Finnish studies which included 36,686 participants, aged 25 to 74 years, who were free of coronary heart disease and stroke at the beginning of the studies.
The participants were weighed and given questionnaires which measured several indicators of their lifestyle, including smoking, body mass index (a measure of healthy vs. unhealthy weight; for an explanation, see Calculate Your Body Mass Index), physical activity, and fruit and vegetable and alcohol consumption.
Based on these data, the researchers divided the study participants into healthy vs. unhealthy cohorts as to each of five healthy lifestyle factors, defined as follows:
- Smoking (Healthy = never vs. Unhealthy = current or ever),
- Body Mass Index (BMI) (Healthy: <25 vs. Unhealthy: ≥25),
- Physical activity (Healthy = moderate or high vs. Unhealthy = low),
- Vegetable consumption (Unhealthy: ≤2 times per week vs. Healthy: ≥3 times per week*), and
- Alcohol consumption (Healthy = 1-209 g/week in men and 1-139 g/week in women vs. Unhealthy = none or ≥210 g/week in men and ≥140 g/week in women).
* Note that the U.S. Department of Agriculture’s Dietary Guidelines for Americans recommends at least 5 to 9 servings of fruits and vegetables per day.
Each person was assigned a healthy lifestyle score based on the number of healthy lifestyle factors they reported. Each person could have a minimum of 0 and maximum of 5 Healthy Lifestyle Factors. More detailed information on how these lifestyle factors were measured and defined is contained in the study.
The researchers found that “a total of 64.2% of participants had at least 3 HLFs [healthy lifestyle factors], 31.2% had at least 4 HLFs, and 7.5% had all 5 HLFs.”
The participants were followed for a period of 13.7 years. During this period, 1,478 people suffered an incident stroke event, including 1,167 ischemic strokes and 311 hemorrhagic strokes.
For a medical definition of the difference between ischemic stroke and hemorrahagic stroke, see the website of the American Stroke Association (part of the American Heart Association).
Using statistical analysis, the researchers measured the extent of association between the five healthy lifestyle factors, alone and in combination, and the participants’ risk of suffering ischemic, hemorrhagic, or any stroke during the study period.
The researchers found that, “In this large prospective study, a combination of HLFs [healthy lifestyle factors]—maintaining normal BMI, eating vegetables regularly (≥3 times per week), practicing a moderate or high level of physical activity, never smoking, and having light to moderate alcohol consumption—was associated with a substantially reduced risk of stroke.”
“These 5 HLFs [healthy lifestyle factors] were significantly associated with a decreased risk of total, ischemic, and hemorrhagic stroke, and the stroke risk progressively decreased as the number of HLFs [healthy lifestyle factors] increased,” the researchers wrote.
“These results also suggest that in this population, most cases of stroke could be avoided by practicing a healthy lifestyle,” the authors concluded.
According to charts of hazard ratios published with their study report, the researchers found that, after controlling for other factors including age, sex, education, family history of stroke, history of diabetes mellitus, systolic blood pressure, and serum total cholesterol level, those who adhered to all five healthy lifestyle factors reduced their risk of suffering a stroke (of any kind) to only 33% of the risk level of those who adhered to none or only one of the healthy lifestyle factors. Those who adhered to four of the healthy lifestyle factors had 51% of the risk of stroke (of any kind) of those with 0 to one healthy lifestyle factor, those who adhered to three healthy lifestyle factors had 57% of the total stroke risk, and those who adhered to two healthy lifestyle factors had 66% of the total stroke risk of those who adhered to 0 to one healthy lifestyle factor.
Thus, the study results suggested that, by adhering to only two healthy lifestyle factors, a person could reduce your total stroke risk by 33%; by adhering to three healthy lifestyle factors, you could reduce your total stroke risk by 43%; by adhering to four healthy lifestyle factors, you could reduce your total stroke risk by 49%; and by adhering to all five healthy lifestyle factors, you could reduce your total stroke risk by fully 67% (a two-thirds reduction in stroke risk).
These results were similar for both men and women, according to the study authors. And, the results were similar, broken out separately for risk of ischemic stroke and hemorrhagic stroke.
The authors summarized their findings in scientific terms, as follows:
“In conclusion,” the authors wrote, “our study demonstrates a graded inverse association between the number of HLFs [healthy lifestyle factors] and the risks of total, ischemic, and hemorrhagic stroke in both men and women. Our findings suggest the important role of promoting a healthy lifestyle in the primary prevention of both ischemic and hemorrhagic stroke.”
As quoted above, the authors concluded, “These results also suggest that in this population, most cases of stroke could be avoided by practicing a healthy lifestyle.”
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