Article Text

Research paper
Impact of a healthy lifestyle on all-cause and cardiovascular mortality after stroke in the USA
  1. Amytis Towfighi1,2,
  2. Daniela Markovic3,
  3. Bruce Ovbiagele4
  1. 1Division of Stroke and Critical Care, Department of Neurology, University of Southern California, Los Angeles, California, USA
  2. 2Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
  3. 3Department of Biomathematics, University of California at Los Angeles, Los Angeles, California, USA
  4. 4Stroke Center and Department of Neurosciences, University of California at San Diego, San Diego, California, USA
  1. Correspondence to Dr A Towfighi, 1510 San Pablo Street, HCC 643, Los Angeles, CA 90033, USA; towfighi{at}


Background Little is known about the effects of a healthy lifestyle on mortality after stroke. This study assessed whether five healthy lifestyle factors had independent and dose dependent associations with all-cause and cardiovascular mortality after stroke.

Methods In a nationally representative sample of the US population (n=15 299) with previous stroke (n=649) followed from survey participation (1988–1994) through to mortality assessment (2000), the relationship between five factors (eating ≥5 servings of fruits/vegetables per day, exercising >12 times/month, having a body mass index of 18.5–29.9 mg/kg2, moderate alcohol use [1 drink/day for women and 2 drinks/day for men] and not smoking) and all-cause and cardiovascular mortality was assessed.

Results Mean age was 67.0 years (SE 1.1 years) and 53% were women. After adjusting for covariates, abstaining from smoking (HR 0.57, CI 0.34 to 0.98) and exercising regularly (HR 0.66, CI 0.44 to 0.99) were associated with lower all-cause mortality but no individual factors had independent associations with cardiovascular mortality. All-cause mortality decreased with higher numbers of healthy behaviours (1–3 factors vs none: HR 0.12, CI 0.03 to 0.47; 4–5 factors vs none: HR 0.04, CI 0.01 to 0.20; 4–5 factors vs 1–3 factors: HR 0.38, CI 0.22 to 0.66; trend p=0.04). Similar effects were observed for cardiovascular mortality (4–5 factors vs none: HR 0.08, CI 0.01 to 0.66; 1–3 factors vs none: HR 0.15, CI 0.02 to 1.15; 4–5 factors vs 1–3 factors: HR 0.53, CI 0.28 to 0.98; trend p=0.18).

Conclusions Regular exercise and abstinence from smoking were independently associated with lower all-cause mortality after stroke. Combinations of healthy lifestyle factors were associated with lower all-cause and cardiovascular mortality in a dose dependent fashion.

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  • Competing interests None.

  • Ethics approval This was a cross sectional study performed by the Centers for Disease Control and all approvals were obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.