Published Online
on August 12, 2008

A more recent version of this article appeared on August 26, 2008

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Submitted on March 19, 2008
Accepted on June 23, 2008

Primary Prevention of Stroke by Healthy Lifestyle

Stephanie E. Chiuve ScD^*, Kathryn M. Rexrode MD, MPH, Donna Spiegelman ScD, Giancarlo Logroscino MD, PhD, JoAnn E. Manson MD, DrPH, and Eric B. Rimm ScD

From the Departments of Nutrition (S.E.C., E.B.R.), Epidemiology (D.S., G.L., J.E.M., E.B.R.), and Biostatistics (D.S.), Harvard School of Public Health, and Division of Preventive Medicine (K.M.R., J.E.M.), and Channing Laboratory (J.E.M., E.B.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: schiuve{at}hsph.harvard.edu.

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/m², 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.

Conclusion—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.

Key words: epidemiology • lifestyle • prevention • risk factors • stroke

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