Modifiable and Non-Modifiable Risk Factors for Atherothrombotic Ischemic Stroke among Subjects in the Malmö Diet and Cancer Study.

Anna Johansson,Stefan Acosta,Isabel Drake,Gunnar Engström

doi:10.3390/nu13061952

Anna Johansson, Stefan Acosta + Show 2 more

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https://doi.org/10.3390/nu13061952

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Journal: Nutrients	Publication Date: Jun 6, 2021
Citations: 22	License type: CC BY 4.0

Affiliation: Lund University, Skåne University Hospital

Abstract

Risk factors for ischemic stroke is suggested to differ by etiologic subtypes. The purpose of this study was to examine the associations between modifiable and non-modifiable risk factors and atherothrombotic stroke (i.e., excluding cardioembolic stroke), and to examine if the potential benefit of modifiable lifestyle factors differs among subjects with and without predisposing comorbidities. After a median follow-up of 21.2 years, 2339 individuals were diagnosed with atherothrombotic stroke out of 26,547 study participants from the Malmö Diet and Cancer study. Using multivariable Cox regression, we examined non-modifiable (demographics and family history of stroke), semi-modifiable comorbidities (hypertension, dyslipidemia, diabetes mellitus and atherosclerotic disease), and modifiable (smoking, body mass index, diet quality, physical activity, and alcohol intake) risk factors in relation to atherothrombotic stroke. Higher age, male gender, family history of stroke, and low educational level increased the risk of atherothrombotic stroke as did predisposing comorbidities. Non-smoking (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.56–0.68), high diet quality (HR = 0.83, 95% CI 0.72–0.97) and high leisure-time physical activity (HR = 0.89, 95% CI 0.80–0.98) decreased the risk of atherothrombotic ischemic stroke independent of established risk factors, with non-significant associations with body mass index and alcohol intake. The effect of the lifestyle factors was independent of predisposing comorbidities at baseline. The adverse effects of several cardiovascular risk factors were confirmed in this study of atherothrombotic stroke. Smoking cessation, improving diet quality and increasing physical activity level is likely to lower risk of atherothrombotic stroke in the general population as well as in patient groups at high risk.

Highlights

During the 21st century cardiovascular disease (CVD) prevalence rates have fallen in most European countries, reduced smoking and improved medical risk factor control being the main reasons [1]
While there is a large body of studies examining the impact of risk factors for all ischemic stroke, including those caused by cardiac embolization due to atrial fibrillation, fewer studies have examined how these risk factors associate with risk for incident atherothrombotic stroke
Individuals with future atherothrombotic stroke were at baseline older, more likely to be male, had a higher stroke heredity, lower educational level, higher body mass index (BMI), consumed less alcohol, were more likely to be current smokers, were less physically active and had a lower diet quality

Summary

Introduction

During the 21st century cardiovascular disease (CVD) prevalence rates have fallen in most European countries, reduced smoking and improved medical risk factor control being the main reasons [1]. While there is a large body of studies examining the impact of risk factors for all ischemic stroke, including those caused by cardiac embolization due to atrial fibrillation, fewer studies have examined how these risk factors associate with risk for incident atherothrombotic stroke. Higher waist to hip ratios and lipoprotein (a) levels were associated with increased risk for non-lacunar stroke, and higher blood levels of von Willebrand factor increased the risk for cardioembolic stroke [7]. These results indicate differences in risk profiles according to subtype of ischemic stroke

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