Association of lifestyle change with incident stroke and its subtypes

Abstract

Objective \xa0To explore the association of lifestyle and its changes with incident stroke in the middle-aged and older population. Methods \xa0A total of 18 293 participants who were free of cardiovascular diseases, cancer, or missing data on lifestyle at baseline were selected and followed until December 2018 from Dongfeng-Tongji cohort. The healthy lifestyle score included the sum of five factors: non-smoking, moderate physical activity, balanced diet, normal weight, and appropriate sleep duration. Cox regression was adopted to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) of lifestyle and its changes with stroke. Results \xa0During the 9.5- years of follow-up, 1 549 (8.5%) stroke events were documented. Comparing with ≤1 score group at baseline, the HR (95% CI) of stroke was 0.83 (0.72-0.95), 0.72 (0.63-0.83), and 0.54 (0.45-0.66) for those with scores of 2, 3, and ≥4, respectively, after adjustment of confounders. The results of five- year lifestyle change (baseline to 2013 follow-up) showed that maintenance of ≥4 scores in healthy lifestyle had 0.39- fold (HR=0.39, 95% CI: 0.23-0.67) risk for incident stroke, compared to maintenance of ≤1 score group. Increment in healthy lifestyle score from 2-3 to ≥4 had 0.55- fold (HR=0.55, 95% CI: 0.37-0.81) risk of incident stroke; improvement from ≤1 to ≥4 scores showed no protective effects for stroke (HR=1.17, 95% CI: 0.58-2.36). Conclusions \xa0Among middle-aged and older Chinese adults, early improvement and long-term maintenance of a healthy lifestyle are most beneficial for preventing and controlling stroke.