Sebina Bulic, MD

Tikk K, Sookthai D, Monni S, Gross ML, Lichy C, Kloss M, and Kaaks R. Primary Preventive Potential for Stroke by Avoidance of Major Lifestyle Risk Factors: The European Prospective Investigation Into Cancer and Nutrition-Heidelberg Cohort. Stroke. 2014

Thanks to the outstanding efforts of stroke community, stroke dropped to fourth leading cause of death. Large epidemiologic studies have identified many modifiable risk factors for stroke. It has been proposed that up to 60-90 % of strokes might be preventable through lifestyle modifications. 

EPIC-Heidelberg is a prospective cohort study that is a part of a large-scale Europe-wide study, the European Prospective Investigation into Cancer and Nutrition (EPIC). Out of 23,927 persons, 551 (195 women and 356 men) had a first diagnosis of stroke during an average follow-up of 12.7 years. All patients completed a general questionnaire and a computer-guided interview about basic demographic factors, prevalent diseases and lifestyle factors. For all study participants weight, height, hip and waist circumferences were measured by trained study nurses.

Effects of general obesity (BMI) and abdominal obesity (waist circumference), smoking, alcohol consumption, diet and physical activity on ischemic, intracerebral or subarachnoid hemorrhage were assessed separately for men and women. The study had some unexpected findings such as associations of general obesity and abdominal obesity with stroke in multivariable models were no longer significant, with the exception of abdominal obesity among women. In men, the risk estimates by different levels of physical activity categories were mostly not statistically significant. No statistically significant association between average lifetime alcohol consumption levels and stroke risk was observed among women. The healthiest diet score was not inversely associated with stroke risk in women. Despite this, it was estimated that from 153 to 94 strokes per 100,000 women and from 261 to 161 strokes per 100,000 men, for the age group 60-65 is preventable. About 38% of stroke cases were estimated as preventable through adherence to a healthy lifestyle profile (never smoking, maintaining optimal body-mass-index and waist circumference, performing physical exercise, consuming a moderate quantity of alcohol and following a healthy dietary pattern). These are estimates of significant potential for stroke risk reduction considering that blood pressure, blood lipids, blood sugar were not taken into consideration.

We are in great need of continuous epidemiological surveillance and identification of modifiable risk factors in fluid stroke prevention and acute stroke management milieu. We need to continue with our efforts to conquer stroke.