... significant risk factors for all stroke were: history of hypertension (OR 2·64, 99% CI 2·26—3·08; PAR 34·6%, 99% CI 30·4—39·1); current smoking (2·09, 1·75—2·51; 18·9%, 15·3—23·1); waist-to-hip ratio (1·65, 1·36—1·99 for highest vs lowest tertile; 26·5%, 18·8—36·0); diet risk score (1·35, 1·11—1·64 for highest vs lowest tertile; 18·8%, 11·2—29·7); regular physical activity (0·69, 0·53—0·90; 28·5%, 14·5—48·5); diabetes mellitus (1·36, 1·10—1·68; 5·0%, 2·6—9·5); alcohol intake (1·51, 1·18—1·92 for more than 30 drinks per month or binge drinking; 3·8%, 0·9—14·4); psychosocial stress (1·30, 1·06—1·60; 4·6%, 2·1—9·6) and depression (1·35, 1·10—1·66; 5·2%, 2·7—9·8); cardiac causes (2·38, 1·77—3·20; 6·7%, 4·8—9·1); and ratio of apolipoproteins B to A1 (1·89, 1·49—2·40 for highest vs lowest tertile; 24·9%, 15·7—37·1). Collectively, these risk factors accounted for 88·1% (99% CI 82·3—92·2) of the PAR for all stroke. When an alternate definition of hypertension was used (history of hypertension or blood pressure greater than 160/90 mm Hg), the combined PAR was 90·3% (85·3—93·7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke.
Interpretation
Our findings suggest that ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke.
Via Clinical Cases and Images.
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