Rx Nutrition Resource Center

Rx Nutrition Resource Center

April 09, 2020
2 min read

Lifestyle, diet modifications decrease stroke risk in middle-aged women

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Goodarz Danaei

Sustained lifestyle modifications in middle-aged women reduced the 26-year risk for ischemic stroke and total stroke, according to a study published in Stroke.

The 26-year risk for total stroke was also reduced with sustained dietary modifications, according to the study.

“The proportion of strokes that can be prevented is higher among patients who are at higher risk of stroke,” Goodarz Danaei, ScD, Bernard Lown Associate Professor of Cardiovascular Health at Harvard T.H. Chan School of Public Health, told Healio. “For example, those who have type 2 diabetes or other risk factors (eg, hypertension, obesity, high serum lipids or history of coronary heart disease). Therefore, doctors should strongly encourage these patients to adopt healthier lifestyles.”

Researchers analyzed data from 59,727 women (mean age at baseline, 52 years; mean BMI, 24.5 kg/m2) from the Nurses’ Health Study who periodically completed questionnaires regarding physician-diagnosed stroke, diet and physical activity.

“It is almost impossible to conduct randomized trials to evaluate the effect of lifestyle on cardiovascular diseases such as stroke,” Danaei said in an interview. “Therefore, the best evidence should come from observational studies with high-quality information such as the Nurses’ Health Study. We also used advanced analytical methods that allow us to emulate the design and analysis of a behavioral intervention trial.”

Diet information was used to calculate usual intake of poultry, processed and unprocessed red meat, nuts, fruits and vegetables, refined grains, whole grains, alcohol and fish.

The risk for total stroke, hemorrhagic stroke and ischemic stroke was estimated between 1986 and 2012 based on moderate to vigorous intensity exercise of at least 30 minutes per day, smoking cessation and BMI reduction by 5%. Researchers investigated several dietary strategies including eating at least one serving of nuts per day, eating three or more servings of fish per week and eating five or more servings of fruits and vegetables per day.

With no lifestyle intervention, the estimated 26-year risk for total stroke was 4.7% (95% CI, 4.5-4.9), 2.5% for ischemic stroke (95% CI, 2.4-2.6) and 0.7% for hemorrhagic stroke (95% CI, 0.6-0.8).

The estimated 26-year risk for total stroke (3.5%; 95% CI, 2.6-4.3) and ischemic stroke (1.6%; 95% CI, 1.1-2.1) decreased with combined nondietary interventions including exercise, smoking cessation and weight loss. Estimated risk for hemorrhagic stroke was similar with most strategies except for an isolated strategy of an increased intake of fish (0.5%; 95% CI, 0.4-0.7).


Isolated dietary strategies of reduced intake of unprocessed red meat and an increased intake of nuts and fish resulted in smaller reductions in the risk for total stroke. The risk for ischemic stroke was also lower with reduced intake of processed and unprocessed red meat.

“The key question is how to encourage adoption of healthy lifestyles and maintain them,” Danaei told Healio. “There is more research now on motivating and incentivizing these behaviors.” – by Darlene Dobkowski

For more information:

Goodarz Danaei, ScD, can be reached at gdanaei@hsph.harvard.edu.

Disclosures: The authors report no relevant financial disclosures.