Wern Yew Ding, MBChB

Ahmed A, Pinto Pereira SM, Lennon L, Papacosta O, Whincup P, Wannamethee G. Cardiovascular Health and Stroke in Older British Men: Prospective Findings From the British Regional Heart Study. Stroke. 2020.

I read with interest the cohort study by Ahmed and colleagues, which sought to evaluate the influence of cardiovascular health on stroke risk. The authors used data from the British Regional Heart Study to identify men with no prior history of cardiovascular disease at baseline who were then re-examined 20 years later. Cardiovascular health was assessed using 7 traditional health metrics, including smoking status, body mass index, level of physical activity, dietary patterns, total cholesterol, blood pressure, and fasting glucose. Outcome data comprised of fatal and non-fatal stroke.

At baseline, there was a total of 7274 men with a mean age of 50 years. As highlighted by the authors, blood pressure was the only parameter at both baseline and 20-year follow-up that was consistently associated with stroke risk in this population. Better levels of physical activity and smoking status at baseline were related to reduced stroke risk, but similar results were not observed using data from 20-year follow-up when the mean age was 69 years. Overall, the authors concluded that stroke prevention strategies should prioritize blood pressure control and other risk factors.

Interestingly, total cholesterol had no effects on stroke risk in both middle-aged and older men. Similar results have previously been reported in the general population.1

A limitation of this study was that it relied on coding data for the outcome of fatal stroke. Furthermore, there was a potential risk of response bias as smoking status, level of physical activity, and diet relied on self-reporting by participants.

Overall, the results of this study are thought-provoking but require further validation. Nonetheless, they suggest that physicians need to consider risk factors in the context of age, and that there is a need to identify modifiable risk factors for primary prevention of stroke in elderly male patients.


1.           Peters SAE, Singhateh Y, Mackay D, Huxley RR, Woodward M. Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis. 2016;248:123–131.