~ 082208 Five Healthy Practices Dramatically Reduce Stroke Risk In Large Study Population

Few conditions are more devastating than stroke, yet an article published ahead of print on August 12, 2008 in the American Heart Association journal Circulation reports that just five healthy lifestyle factors may confer significant protection against the event.

For the current study, researchers at Harvard School of Public Health and Harvard Medical School evaluated data from 43,685 men who participated in the Health Professionals Follow-up Study and 71,243 women from the Nurses' Health Study. Information concerning lifestyle factors was obtained from questionnaires completed by the subjects at several time points during the studies' follow-up periods. The researchers identified five characteristics of a low-risk lifestyle: not smoking, having a body mass index of less than 25 kilograms per cubic meter, participating in at least 30 minutes per day of moderate activity, modest alcohol intake (defined as 5 to 30 grams per day for men and 5 to 15 grams per day for women), and a high healthy diet score. Diets were scored according to their adherence to components of the US Department of Agriculture Healthy Eating Index, which includes increased intakes of vegetables, fruit, nuts, soy, and cereal fiber; higher ratios of chicken plus fish to red meat, and polyunsaturated to saturated fat; low trans fat intake, and at least five years of multivitamin use. Adherence to the DASH diet and the 6-nutrient diet associated with a lower risk of coronary heart disease in the Nurses' Health Study were also included in the diet score.

Over the studies' follow-up periods, 600 ischemic and 161 hemorrhagic strokes occurred among the men, and 853 ischemic and 278 hemorrhagic strokes were documented among the women. For men who reported practicing all five healthy lifestyle factors, a 69 percent reduction in total stroke risk and an 80 percent reduction in the risk of ischemic stroke were observed compared with the risk experienced by men who reported none of the factors. Among women with all healthy factors, the reduction in total stroke risk was 79 percent, and for ischemic stroke, the risk was 81 percent lower. It was determined that 35 percent of men's total strokes and 52 percent of their ischemic strokes were attributable to failure to follow a low-risk lifestyle. For women, the number was higher, with 47 percent of all strokes and 54 percent of ischemic strokes due to unhealthy lifestyle. A greater risk of hemorrhagic stroke was also associated with failure to follow a healthy lifestyle, but the association was weaker than that of total and ischemic stroke.

"We found that a low-risk lifestyle is associated with lower risk of stroke, especially ischemic stroke, which adds to the data on the prevention of multiple chronic diseases, including coronary heart disease and diabetes," the authors conclude. "This study further supports the beneficial impact of a low-risk lifestyle on the primary prevention of chronic disease and long-term well-being."

Related Health Concern: Stroke and cerebrovascular disease

Cerebrovascular disease, including stroke, is the third-leading cause of death in the United States and a leading cause of disability among older Americans. Cerebrovascular disease occurs when the blood vessels supplying the brain with oxygenated blood are damaged or their function is compromised. If the blood flow is severely restricted, depriving the brain of adequate oxygen even briefly, a stroke can occur. It has been estimated that every 45 seconds, another American suffers from a stroke, often with debilitating consequences or even death. One in four men and one in five women over the age of 45 will suffer a stroke.

Stroke prevention is a subject of much debate. Approximately 25 percent of people who recover from a first stroke will have a second within five years. While the chance of death and disability increases with each stroke, risk of another stroke appears to be greatest within the first year (National Stroke Association 2005).

Multiple studies have found that a diet high in fruits and vegetables lowers risk of cerebrovascular disease and both ischemic and hemorrhagic stroke (Gariballa SE 2000; Sauvaget C et al 2003). Two major reviews recommended that public health policy promote increased dietary intake of antioxidant vitamin C, beta-carotene, vitamin E, B vitamins (including folate), potassium, calcium, magnesium, vitamin D, fiber, and omega-3 fatty acids to reduce risk of stroke (Gariballa SE 2000; Johnsen SP 2004). These vital nutrients can also be obtained through dietary supplements in conjunction with a healthy diet.

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