Healthy diet and lifestyle and risk of stroke in a prospective cohort of women

Objective: To investigate the association between a low-risk lifestyle and risk of stroke. Methods: The study population comprised 31,696 women, in the population-based Swedish Mammography Cohort who at baseline had completed a questionnaire about diet and lifestyle and were free from cardiovascular disease and cancer. We defined a low-risk lifestyle as a healthy diet (top 50% of a Recommended Food Score), moderate alcohol consumption (5–15 g/d), never smoking, physically active (walking/bicycling ≥40 min/d and exercise ≥1 h/wk), and body mass index below 25 kg/m2. Stroke cases were identified from the Swedish National Patient Register and the Swedish Cause of Death Register. Results: We ascertained 1,554 incident stroke cases, including 1,155 cerebral infarctions, 246 hemorrhagic strokes, and 153 unspecified strokes during 10.4 years of follow-up. The risk of stroke, in particular cerebral infarction, decreased steadily with increasing number of low-risk lifestyle factors. Compared with no low-risk factors, the multivariable relative risks (95% confidence interval) of cerebral infarction across increasing number of low-risk factors (1–5) were 0.72 (0.56–0.93), 0.67 (0.52–0.85), 0.57 (0.44–0.74), 0.54 (0.40–0.73), and 0.38 (0.20–0.73). Conclusions: These findings indicate that a low-risk lifestyle can substantially reduce the risk of stroke, especially cerebral infarction.