Lifestyle Factors on the Risks of Ischemic and Hemorrhagic Stroke

Zhang, Yurong; Tuomilehto, Jaakko; Jousilahti, Pekka; Wang, Yujie; Antikaínen, Riitta; Hu, Gang

doi:10.1001/archinternmed.2011.443

Cited by 126 publications

(122 citation statements)

References 45 publications

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“…In this large prospective cohort of older Chinese people, current smoking was associated with a higher risk of death from total and ischemic stroke, consistent with several previous large prospective cohort studies in Western populations, [14][15][16] in terms of RR, supporting the validity of our data. 6 Furthermore, for the first time we showed that cigarette smoking was associated with a higher mortality risk of hemorrhagic stroke and both its major subtypes, ie, ICH and SAH, based on a large community-based sample and a sufficient follow-up period.…”

Section: Discussionsupporting

confidence: 92%

Smoking and Hemorrhagic Stroke Mortality in a Prospective Cohort Study of Older Chinese

Schooling

Chan

et al. 2013

Stroke

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Background and Purpose-Hemorrhagic stroke is more common in non-Western settings and does not always share risk factors with other cardiovascular diseases. The association of smoking with hemorrhagic stroke subtypes has not been established. We examined the association of cigarette smoking with hemorrhagic stroke, by subtype (intracerebral hemorrhage and subarachnoid hemorrhage), in a large cohort of older Chinese from Hong Kong. Methods-Multivariable Cox regression analysis was used to assess the adjusted associations of smoking at baseline with death from hemorrhagic stroke and its subtypes, using a population-based prospective cohort of 66 820 Chinese aged >65 years enrolled from

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Section: Discussionsupporting

confidence: 92%

Smoking and Hemorrhagic Stroke Mortality in a Prospective Cohort Study of Older Chinese

Schooling

Chan

et al. 2013

Stroke

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“…We also examined the associations between each individual health metric and stroke risk. Although ischemic stroke and intracerebral hemorrhagic stroke share some common risk 12,14,[17][18][19][20] our study showed significant associations between each ideal health behavior/factor and the risks of total and ischemic stroke. We did not find a significant relationship between health behaviors and intracerebral hemorrhagic stroke.…”

Section: Discussionmentioning

confidence: 56%

“…13 In another study comprising 36 686 Finnish participants, in which 1167 ischemic and 311 hemorrhagic strokes were confirmed, an inverse association was observed between the number of healthy lifestyle indicators (including smoking, BMI, physical activity, and consumptions of vegetables and alcohol) and the risks of total stroke and its 2 major subtypes (ischemic and hemorrhagic stroke). 14 However, in the Women's Health study, a lifestyle score based on the 5 similar lifestyle factors as described above was found to be inversely associated with the risks of total (450 incident cases) and ischemic stroke (356 cases), rather than hemorrhagic stroke (90 cases). 15 Our results on the stroke subtype pattern were also consistent with previous studies performed in Asia, showing a higher proportion of hemorrhagic stroke (20% to 30% of total stroke) 16 than that in the Western populations.…”

Section: Discussionmentioning

confidence: 93%

Ideal Cardiovascular Health Metrics and the Risks of Ischemic and Intracerebral Hemorrhagic Stroke

Zhang

Zhou

Gao

et al. 2013

Stroke

187

195

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Background and Purpose-Previous studies showed an inverse association between ideal cardiovascular health (CVH) metrics and the total risk of cardiovascular diseases and stroke. This study aimed to investigate the relationship between ideal CVH metrics and the risks of ischemic and hemorrhagic stroke, respectively. Methods-We collected information on the 7 ideal CVH metrics (including smoking status, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose) among 91 698 participants from the Kailuan study, China (72 826 men and 18 872 women between the ages of 18 and 98 years), free of myocardial infarction and stroke at baseline (2006)(2007). Cox proportional hazards models were used to estimate stroke risk. Results-During the 4-year follow-up, we identified 1486 incident stroke events (1057 ischemic, 386 intracerebral hemorrhagic, and 43 subarachnoid hemorrhagic). The hazard ratios (95% confidence interval) for total stroke with adherence to 0 (reference), 1, 2, 3, 4, 5, and 6/7 ideal CVH metrics were: 1, 0.92 (0.69-1.23), 0.69 (0.52-0.92), 0.52 (0.39-0.68), 0.38 (0.28-0.51), 0.27 (0.18-0.40), and 0.24 (0.11-0.54), respectively (P trend <0.01), after adjusting for age, sex, education, income, and hospital. Similar inverse associations were observed for both ischemic and intracerebral hemorrhagic stroke (both P trend <0.01). Conclusions-We

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“…[3][4][5][6] The objective of the present study was to examine the combined effect of multiple low-risk lifestyle factors (healthy diet, 7 moderate alcohol consumption, never smoking, physically active, and healthy body weight) on incidence of total stroke and stroke types in a population-based prospective cohort of Swedish women.…”

Section: Methodsmentioning

confidence: 99%

“…3 The association between 5 healthy lifestyle factors and risk of stroke was also examined in a cohort of 36,686 Finnish women and men. 5 In that study, participants with all 5 low-risk lifestyle factors (vegetable consumption $3 times/wk, alcohol intake $140 g/wk in women and $210 g/wk in men, never smoker, moderate or high physical activity, and BMI ,25 kg/m 2 ) had a 70% lower risk of cerebral infarction compared with those with no low-risk factors. 5 A healthy lifestyle, based on 3 food groups (fruits, fish, and milk) and 5 other factors (alcohol consumption, physical activity, BMI, smoking, and sleep duration), was associated with a similar reduction in stroke in a cohort of Japanese women and men.…”

mentioning

confidence: 90%

Healthy diet and lifestyle and risk of stroke in a prospective cohort of women

Braillon¹,

Larsson²,

Åkesson³

2015

Neurology

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Objective: To investigate the association between a low-risk lifestyle and risk of stroke. Methods:The study population comprised 31,696 women, in the population-based SwedishMammography Cohort who at baseline had completed a questionnaire about diet and lifestyle and were free from cardiovascular disease and cancer. We defined a low-risk lifestyle as a healthy diet (top 50% of a Recommended Food Score), moderate alcohol consumption (5-15 g/d), never smoking, physically active (walking/bicycling $40 min/d and exercise $1 h/wk), and body mass index below 25 kg/m 2 . Stroke cases were identified from the Swedish National Patient Register and the Swedish Cause of Death Register. Stroke is a major cause of disability and mortality. Because the consequences of stroke are usually devastating and irreversible, primary prevention is of great importance. Hypertension is a strong and well-documented risk factor for stroke.1 Diet, alcohol consumption, smoking, physical activity, and adiposity can modify blood pressure and thus the risk of stroke.1,2 Few studies have examined the combined effect of a low-risk lifestyle on the incidence of stroke. [3][4][5][6] The objective of the present study was to examine the combined effect of multiple low-risk lifestyle factors (healthy diet, 7 moderate alcohol consumption, never smoking, physically active, and healthy body weight) on incidence of total stroke and stroke types in a population-based prospective cohort of Swedish women.METHODS Study population. For the present study, we used data from the Swedish Mammography Cohort, which has been described in detail previously. 8 Briefly, in the autumn of 1997, 39,227 women who resided in Uppsala and Västmanland counties, central Sweden, and were born between 1914 and 1948 completed a 350-item questionnaire concerning diet and lifestyle.Standard protocol approvals, registrations, and patient consents. The Regional Ethical Review Board at Karolinska Institutet in Stockholm, Sweden, approved this study. Return of the completed questionnaire was considered to imply informed consent.Assessment of lifestyle factors. At baseline in 1997, all participants of the Swedish Mammography Cohort completed a selfadministered questionnaire that solicited information on education, body weight, height, smoking, physical activity, use of aspirin, history of hypertension and diabetes, family history of myocardial infarction before the age of 60 years, alcohol consumption, and diet. Participants indicated how many minutes or hours per day they had walked/bicycled (almost never, ,20 min/d, 20-40 min/d,

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Lifestyle Factors on the Risks of Ischemic and Hemorrhagic Stroke

Abstract: 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.

Cited by 126 publications

References 45 publications

Smoking and Hemorrhagic Stroke Mortality in a Prospective Cohort Study of Older Chinese

Smoking and Hemorrhagic Stroke Mortality in a Prospective Cohort Study of Older Chinese

Ideal Cardiovascular Health Metrics and the Risks of Ischemic and Intracerebral Hemorrhagic Stroke

Healthy diet and lifestyle and risk of stroke in a prospective cohort of women

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