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Behaviors that Reduce the Risk of Stroke

EPIC Study Demonstrates the Benefits of a Healthy Lifestyle

Mar 1, 2009 Stephen Allen Christensen

Observational and controlled clinical trials continue to show an association between a healthy lifestyle and a reduced risk of cardiovascular disease in all populations.

A recently completed British study, the European Prospective Investigation of Cancer-Norfolk (EPIC-Norfolk), demonstrates that practicing four specific behaviors reduces the incidence of stroke in both men and women. Furthermore, the trial shows that people who practice only a portion of these behaviors enjoy a partial reduction of stroke occurrence in comparison to people who don’t engage in any of the behaviors.

In a group of over 20,000 people between the ages of 40 and 79 with no history of prior stroke or heart attack, scientists evaluated the impact of lifestyle—as measured by adherence to the specified behaviors—on both total and cause-specific (i.e., due to stroke, heart attack, cancer, etc.) mortality.

For individuals who exhibited all four habits, the relative risk of having a stroke was assigned a value of 1. The relative risks for men and women who practiced fewer than four habits were as follows: for three health behaviors, 1.15 (that is, these individuals were slightly more prone to stroke than those who practiced all four habits); for two health behaviors, 1.58; for one health behavior, 2.18 (i.e., more than twice the risk); for no health behaviors, 2.31.

Relative risks were all statistically significant at a 95% confidence interval, and risks were assigned after adjusting for age, gender, body mass index, systolic blood pressure, serum cholesterol, history of diabetes, and socioeconomic class. In other words, even after adjusting for well-known risk factors for stroke, people who practiced any of the targeted health behaviors had a lower risk of stroke than similar study participants who adhered to none of them.

Behaviors (Habits) That Help to Prevent Stroke

Each of the trial’s participants was assigned a score from 0 to 4, receiving one point for each of the following targeted behaviors:

Currently nonsmoking
Physically not inactive (A physically inactive person was defined as one having a sedentary job with no recreational activity; a physically NOT inactive person was any person with an activity level higher than that of a physically inactive person)
Moderate alcohol intake, defined as drinking 1 to 14 units of alcohol weekly. (One unit was defined as eight grams of alcohol, equivalent to one ounce of spirits, one-half pint of beer, or one glass of wine. A score of 1 was assigned to moderate drinkers; a score of 0 was assigned to individuals consuming less than one or more than 14 units of alcohol weekly)
Fruit and vegetable intake of five or more servings daily (reflected by a measured plasma concentration of vitamin C of ≥50 µmol/L)

EPIC’s authors wrote: “Four health behaviors combined predict more than a twofold difference in incidence of stroke in men and women. These results provide further incentive and support for the notion that small differences in lifestyle can have a substantial potential impact on risk.” (Myint P, et al. Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study. BMJ 2009;338:b349)

In a review of EPIC’s conclusions, Dr. Matthew Giles, from the Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford, UK, confirmed the association between the risk of stroke and health behaviors: “The conclusion that lifestyle predicts the risk of stroke should help to inform individuals’ choices and policy makers’ decisions. However, what is…less encouraging is the small proportion of participants with a lifestyle that protects against stroke. Although lifestyle interventions could be of great benefit, a huge shift in behavior will be needed to achieve this.” (Giles M. Risk of stroke and lifestyle. BMJ 2009;338: b14)

The copyright of the article Behaviors that Reduce the Risk of Stroke in General Medicine is owned by Stephen Allen Christensen. Permission to republish Behaviors that Reduce the Risk of Stroke in print or online must be granted by the author in writing.