Published: Jun 7, 2013 | Updated: Jun 6, 2013
By Todd Neale , Senior Staff Writer, MedPage Today

Action Points

• This analysis of a prospective cohort study demonstrated that a lifestyle score was associated with stroke risk.
• Be aware that less than half of the REGARDS study participants provided lifestyle information.

Meeting American Heart Association/American Stroke Association criteria for at least average cardiovascular health may lower the risk of stroke, researchers found.

The risk of incident stroke was significantly lower for individuals who had average or optimum cardiovascular health compared with those who had poor cardiovascular health based on the organizations’ Life’s Simple 7 (LS7) score, which incorporates three health factors and four lifestyle factors, according to Ambar Kulshreshtha, MD, MPH, of Emory University in Atlanta, and colleagues.

Each improvement in category was associated with a 25% lower risk of stroke (HR 0.75, 95% CI 0.63-0.90), the researchers reported online in Stroke: Journal of the American Heart Association.

In addition, each 1-point increase in the score — which equates to improvement from poor to intermediate or intermediate to ideal on just one of the seven factors included in the score — was associated with an 8% lower risk of stroke (HR 0.92, 95% CI 0.88-0.95).

“Our study supports this idea that making small changes in lifestyle can have a huge impact in reducing stroke burden,” Kulshreshtha said in an interview, adding, however, that it remains to be tested which multidisciplinary interventions will work at the population level to reduce the burden of stroke.

The AHA/ASA released the framework that would become Life’s Simple 7 in 2010. The score incorporates information on blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet to provide an assessment of cardiovascular health.

Higher scores have been associated with reductions in the risks of cardiovascular mortalityand all-cause mortality, but fewer data exist regarding stroke risk.

Kulshreshtha and colleagues explored the issue using data from the REGARDS study, a national, population-based cohort study of stroke among blacks and whites ages 45 and older. The current analysis included 22,914 individuals (mean age 65) with available information about the factors included in the score and no history of cardiovascular disease.

For each participant, the seven components of the score were classified as poor (0 points), intermediate (1 point), or ideal (2 points). A score was then given to the participants, who had their cardiovascular health classified as inadequate (0 to 4 points), average (5 to 9 points), or optimum (10 to 14 points).

The percentage of patients with poor or ideal status for each of the factors varied widely. For example, 84% had ideal status for smoking but 0% had ideal status for diet.

There were some racial differences, as well. The average LS7 score was lower among blacks compared with whites (6.5 versus 7.6) and blacks were less likely to have optimum cardiovascular health (7% versus 19%).

During a follow-up lasting more than 4.9 years, there were 432 incident stroke adjudicated by neurologists. The stroke rate (per 10,000 person-years) ranged from 1.3 for those with optimum cardiovascular health to 2.4 for those with an inadequate status.

After adjustment for demographics, socioeconomic status, and region of residence, the risk of stroke was significantly lower for participants with average cardiovascular health (HR 0.72, 95% CI 0.55-0.96) and optimum health (HR 0.52, 95% CI 0.35-0.76) compared with those with poor health.

The relationships were consistent among blacks and whites.

“This provides confidence that meeting the AHA goals for LS7 may lead to reduction in stroke incidence,” the researchers wrote.

Kulshreshtha noted that when considering stroke risk not all LS7 components are equal — blood pressure appears to be more important because ideal status on that factor was associated with the largest drop in stroke risk compared with the other factors (HR 0.40, 95% CI 0.3-0.6).

He and his co-authors acknowledged that the study was limited in that health factors and behaviors were measured only once, resulting in the possibility of some misclassification. In addition, the cooperation rate in REGARDS was 49%, which could limit the generalizability of the results, and the researchers used a modified definition for physical activity and diet for computing the LS7 score.

From the American Heart Association:

• Primary Prevention of Stroke
• AHA Heart Disease and Stroke Statistics 2013 Update
• Unveiling Goals for Health Promotion and Disease Reduction