Control of Lifestyle Risk Factors Lowers Mortality After Stroke

Many patients who suffer stroke, even minor stroke, enter a period of depression or have feelings of helplessness and hopelessness. This may result in a decreased motivation or willingness to make changes to avoid further vascular disease.

A study reported this week at the AAN meeting suggests that managing at least 4 of 7 changes after a stroke is life-preserving:

1. Not smoking

2. Regular physical activity (exercise)

3. Eating a healthy diet

4. Maintaining normal weight

5. Controlling serum cholesterol (LDL)

6. Keeping blood pressure normal

7. Keeping blood glucose levels under control.

Note that even though points 5, 6, and 7 might require medications, the first 4 can be often be manged without any additional medications.

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ABSTRACT

M Lin, D Markovic, B Ovbiagele, A Towfighi

The association between meeting Life's Simple 7 goals and mortality after stroke in the US

Summary: Individuals who met a greater number of the Life's Simple 7 cardiovascular health metrics as put forth by the American Heart Association had a lower all-cause mortality after stroke in an inverse dose-dependent fashion. Results from this study suggest that interventions specifically targeting these 7 factors--not smoking, regular physical activity, eating a healthy diet, maintaining normal weight, and controlling serum cholesterol, blood pressure, and blood glucose levels--could have a profound impact on long-term outcomes after stroke.

Methods:

Researchers conducted this study to determine the association between cardiovascular health metric scores and all-cause mortality after stroke.

They assessed all-cause mortality among a nationally representative sample of US adults (≥18 years) with self-reported stroke (n=649), from participation in NHANES in 1988-1994 through mortality assessment in 2006.

They also assessed the adherence of participants to the AHA's Life's Simple 7, which ranged from 0 to 7, and calculated adjusted survival curves for cumulative all-cause mortality by the cardiovascular health metrics under the Cox proportional hazards model after adjustment for socio-demographic factors and trend tests for difference in mortality risk across health metric score under this model.

Results:

Less than 1% of all stroke survivors met all 7 ideal health metrics.

Over a median duration of 98 months (range 53-159), researchers observed a dose-dependent relationship between number of ideal lifestyle metrics met and 10-year adjusted mortality: 0-1: 57%; 2: 48%; 3: 43%; 4: 36%, and ≥5: 30%.

Those who met ≥4 health metrics had significantly lower mortality rates than those who met 0-1 (HR 0.51; 95% CI 0.28-0.92).

After adjusting for socio-demographics (age, sex, race, income, and education), higher health metrics score was associated with reduced risk of all-cause mortality (trend P-value: 0.022).