Lifestyle Factors and Acute Stroke Outcome

Study Questions:

Are lifestyle factors associated with stroke severity?

Methods:

Patients were identified using the Danish Stroke Registry, which includes records of all hospitals treating patients for acute stroke. Patients ages ≥18 years presenting with acute stroke (first event) between January 13, 2003 and December 31, 2011 were included in the present analysis. Lifestyle factors included in the analysis were body mass index (BMI), smoking status, and alcohol intake. Patients were grouped by lifestyle factors into healthy (nonsmoker, alcohol intake ≤21/14 drinks per week, BMI >18.5 and <24.9 kg/m2); moderately healthy (one adverse lifestyle factor, either current/former smoker or alcohol intake >21/14 drinks per week, or BMI <18.5 or >24.9 kg/m2); or moderately unhealthy (two of the following four adverse lifestyle factors (current/former smoker, alcohol intake >21/14 drinks per week, and BMI <18.5 or >24.9 kg/m2).

Results:

A total of 82,597 patients were included in the study. A total of 18.3% had a severe stroke, 7.8% pneumonia, 12.5% urinary tract infection, and 9.9% died within 30 days. Evidence of effect modification by sex was observed for stroke severity and 30-day mortality. An unhealthy lifestyle was associated with lower risk of severe stroke (adjusted odds ratio [OR], 0.73; 95% confidence interval [CI], 0.63-0.84) and 30-day mortality among men (adjusted OR, 0.71; 95% CI, 0.58-0.87), but not among women (severe stroke: adjusted OR, 1.14; 95% CI, 0.85-1.55, and mortality: adjusted OR, 1.34; 95% CI, 0.90-1.99). No sex differences were found for pneumonia and urinary tract infection. Unhealthy lifestyle was not associated with a statistically significant increased risk of developing in-hospital pneumonia (adjusted OR, 1.30; 95% CI, 0.98-1.73) or urinary tract infection (adjusted OR, 0.98; 95% CI, 0.72-1.33). Being underweight was associated with a higher 30-day mortality for men (adjusted OR, 1.71; 95% CI, 1.50-1.96) and for women (adjusted OR, 1.46; 95% CI, 1.34-1.60).

Conclusions:

The authors concluded that a healthy lifestyle was not associated with a lower risk of adverse stroke outcomes, among men in particular. However, underweight may be a particular concern, as it was associated with an increased risk of adverse outcomes among both sexes.

Perspective:

The data suggest that being underweight, rather than being obese, increases the risk for adverse outcomes after stroke. Since the data on other lifestyle factors including diet and physical activity were missing, additional cohorts may shed light on the effect of BMI on stroke severity.


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