Ideal CV health scores confer lower risk for most stroke subtypes
Ideal American Heart Association CV health scores were associated with substantially lower risks for stroke, ischemic stroke, intracerebral hemorrhage and unspecified stroke, but not subarachnoid hemorrhage, researchers reported.
“Previous studies ... showed that better CV health was associated with lower risks of stroke; however, there were also some studies that found no significant association between global CV health score and stroke,” Zhi Cao, MD, from the School of Public Health at Tianjin Medical University and the department of big data in health science at the School of Public Health and Zhejiang University School of Medicine in Hangzhou, China, and colleagues wrote in EClinicalMedicine, a clinical journal published by The Lancet. “Moreover, data are sparse regarding the influence of behavioral and biological CV health status on the risks of stroke subtypes, including ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage.”
The AHA Life’s Simple 7 measures of ideal CV health include smoking, diet, physical activity and BMI as behavioral metrics and blood glucose, blood cholesterol and BP as biological metrics.
The researchers analyzed 354,976 participants (55% women) aged 40 to 70 years without stroke and CHD from the UK Biobank from 2006 to 2010 who were followed up to 2020. Participants’ CV scores were categorized into poor, intermediate and ideal groups.
During a median follow-up period of 11 years, researchers observed 5,804 incident stroke cases that included 3,664 cases of ischemic stroke, 714 cases of intracerebral hemorrhage, 453 cases of subarachnoid hemorrhage and 426 cases of unspecified stroke. In the cohort, 21.2% of participants were categorized as having poor CV health scores, 64.3% were categorized as intermediate and 14.5% were categorized as ideal.
There was a significant reduction in risk for stroke with both increasing behavioral CV health scores (HR = 0.9; 95% CI, 0.88-0.91) and biological CV health scores (HR = 0.82; 95% CI, 0.8-0.84). Participants in the ideal behavioral CV health group demonstrated significantly lower risks for all stroke subtypes. Those in the ideal biological CV health group had reduced risk for all stroke events except subarachnoid hemorrhage (HR = 1.24; 95% CI, 0.88-1.76), according to the researchers.
Each 1-point increment in global CV health score was associated with 13% lower risk for ischemic stroke and unspecified stroke, 11% lower risk for stroke and 8% lower risk for intracerebral hemorrhage. Overall, participants with poor behavioral and biological CV health had a nearly threefold increased risk for stroke compared with participants with ideal behavioral and biological CV health scores (HR = 2.78; 95% CI, 2.36-3.28).
Researchers observed no significant dose-dependent association between global CV health and subarachnoid hemorrhage.
“Our study highlights the benefits of maintaining better CV health across the life course and call attention to the need for comprehensive strategies to preserve and restore high CV health score to prevent stroke events,” the researchers wrote.