Cited by 29Cardiovascular Health and Risk FactorsAcute Ischemic Stroke ManagementNutritional Studies and Diet

Hypothetical lifestyle strategies in middle-aged women and the long-term risk of stroke

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Jain, Priyanka, Suemoto, Claudia K., Rexrode, Kathryn, Manson, JoAnn E., Robins, James M., Hernán, Miguel A., Danaei, Goodarz·2020·Stroke

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%.

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Crossref · 10.1161/strokeaha.119.026761

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43 of 43 references verified0 citation errors · 0 not checkable

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  • Among those 10 papers, 4 (40%) suggested a significant effect of physical activity on ischemic stroke in women but not in men.

    “4 (40%) suggested a significant effect in women but not in men”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [43]

    The Results report a lower estimated risk of ischemic stroke under a daily-exercise strategy in middle-aged women. The paper studied women only, so it cannot support the comparison with men; it also does not establish the citing document’s count of four out of ten papers. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • For incident ischemic stroke among women, of 19 papers, 11 (58%) reported evidence for a protective effect of physical activity.

    “For estimates of the association between measures of physical activity and incident ischemic stroke among women, of 19 papers, 11 (58%)32,43,46,49,51,53,55,57,61–63 reported evidence for a protective effect of physical activity”

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  1. [40]Xun P, Qin B, Song Y, Nakamura Y, Kurth T, Yaemsiri S, Fish consumption and risk of stroke and its subtypes: accumulative evidence from a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2012; 66: 1199– 1207. 23031847 PMC6063513

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Authors
Jain, P., Suemoto, C. K., Rexrode, K., Manson, J. E., Robins, J. M., Hernán, M. A., & Danaei, G.
Affiliations
  • Harvard University (US)
  • Division of Geriatrics, University of São Paulo Medical School, Brazil (C.K.S.)
  • Brigham and Women's Hospital (US)
  • From the Department of Epidemiology (P.J., J.E.M., J.M.R., M.A.H., G.D.), Harvard T.H. Chan School of Public Health, Boston, MA
Corresponding author
Danaei, Goodarz
Venue
Stroke
Published
2020-05
Volume
51
Issue
5
Pages
1381-1387
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
OpenAlex
W3015625011
Cited by
29
References
44
Citations by year
2026: 7 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 2
FWCI
2.32
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Stroke (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
Funders
  • National Institutes of Health (5r01ca049449-18)
  • National Heart, Lung, and Blood Institute (R01HL034594, R01HL088521)
  • National Cancer Institute (P01CA087969, R01‐CA049449, UM1CA186107)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
stroke risk, lifestyle intervention, middle-aged women, smoking cessation, physical activity, body mass index reduction, fish consumption, red meat consumption, processed meat, nuts, ischemic stroke, hemorrhagic stroke, parametric g-formula, Nurses' Health Study
MeSH terms
Adult, Aged, Feeding Behavior, Female, Follow-Up Studies, Humans, Life Style, Middle Aged, Surveys and Questionnaires, Risk Factors, Time, Exercise, Incidence, Stroke

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