Middle age may not be too late for women to substantially reduce their stroke risk by not smoking, exercising, maintaining a healthy weight and making healthy food choices, according to research. In general, women are more likely than men to have a stroke, die from stroke and have poorer health and physical function after a stroke. The average age of first stroke in women is 75 years. Based on this information, researchers theorised that making mid-life lifestyle changes might help reduce stroke's burden among women.
"We found that changing to a healthy lifestyle, even in your 50s, still has the potential to prevent strokes," said Dr Goodarz Danaei, lead study author and Bernard Lown associate professor of cardiovascular health at Harvard TH Chan School of Public Health in Boston. "Women who made lifestyle modifications in middle age reduced their long-term risk of total stroke by nearly a quarter and ischemic stroke, the most common type of stroke, by more than one-third."
Researchers analysed the Nurses' Health Study, which includes health information on nearly 60,000 women who enrolled at average age of 52 and continued in the study for an average of 26 years. Researchers studied the impact on stroke risk from smoking cessation, exercising 30 minutes or more daily and gradual weight loss if women were overweight. The researchers also studied the impact of making recommended dietary modifications that emphasise eating more fish, nuts, whole grains, fruits and vegetables and less red meat, no processed meat and less alcohol.
During the 26-year follow-up, researchers found:
4.7% of women with no lifestyle interventions had a stroke of any type; 2.4% had ischemic stroke; and 0.7% had haemorrhagic stroke.
Engaging in the three non-dietary interventions – smoking cessation, daily exercise and weight loss – was estimated to reduce the risk of total stroke by 25% and ischemic stroke by 36%.
Sustained dietary modifications were estimated to reduce the risk of total stroke by 23%.
Researchers also found that increasing fish and nut consumption and reducing unprocessed red meat consumption appeared to have positive impacts on reducing stroke risk, although the degree of impact from these dietary changes was not as big as those achieved through increased physical activity, smoking cessation and maintaining a healthy weight.
While this was an observational study that included mostly white, middle-aged women, Danaei said, "there are other studies to support that the proportional changes in stroke risk from lifestyle and dietary modifications may be generalizable to men. We also estimate that exercising 30 minutes or more daily may reduce the risk of stroke by 20%."
Abstract
Background and Purpose: Long-term effect of lifestyle changes on stroke incidence has not been estimated in randomized trials. We used observational data to estimate the incidence of stroke under hypothetical lifestyle strategies in the NHS (Nurses’ Health Study).
Methods: We considered 3 nondietary strategies (smoking cessation, exercising ≥30 min/d, gradual body mass index reduction if overweight/obese) and several dietary strategies (eating ≥3 servings/wk of fish, ≤3 servings/wk of unprocessed red meat, no processed red meat, ≥1 servings/d of nuts, etc). We used the parametric g-formula to estimate the 26-year risk of stroke under these strategies.
Results: In 59 727 women, mean age 52 years at baseline in 1986, the estimated 26-year risks under no lifestyle interventions were 4.7% for total stroke, 2.4% for ischemic stroke, and 0.7% for hemorrhagic stroke. Under the combined nondietary interventions, the estimated 26-year risk of total stroke was 3.5% (95% CI, 2.6%–4.3%) and ischemic stroke was 1.6% (95% CI, 1.1%–2.1%). Smaller reductions in total stroke risk were estimated under isolated dietary strategies of increased intake of fish and nuts and reduced intake of unprocessed red meat. Ischemic stroke risk was lower under reduced intake of unprocessed and processed red meat, and hemorrhagic stroke risk was lower under a strategy of increased fish consumption.
Conclusions: In this population of middle-aged women, sustained, lifestyle modifications were estimated to reduce the 26-year risk of total stroke by 25% and ischemic stroke by 36%. Sustained dietary modifications were estimated to reduce the 26-year risk of total stroke by 23%.
Authors
Priyanka Jain, Claudia K Suemoto, Kathryn Rexrode, JoAnn E Manson, James M Robins, Miguel A Hernán, Goodarz Danaei
[link url="https://www.sciencedaily.com/releases/2020/04/200409085637.htm"]Harvard TH Chan School of Public Health material[/link]
[link url="https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.026761"]Stroke abstract[/link]