Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study

Phyo K Myint, Robert N Luben, Nicholas J Wareham, Sheila A Bingham, Kay-Tee Khaw

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Abstract

OBJECTIVE: To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community.

DESIGN: Population based prospective study (EPIC-Norfolk).

SETTING: Norfolk, United Kingdom.

PARTICIPANTS: 20,040 men and women aged 40-79 with no known stroke or myocardial infarction at baseline survey in 1993-7, living in the general community, and followed up to 2007.

MAIN OUTCOME MEASURE: Participants scored one point for each health behaviour: current non-smoking, physically not inactive, moderate alcohol intake (1-14 units a week), and plasma concentration of vitamin C >or=50 micromol/l, indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from 0 to 4.

RESULTS: There were 599 incident strokes over 229,993 person years of follow-up; the average follow-up was 11.5 years. After adjustment for age, sex, body mass index (BMI), systolic blood pressure, cholesterol concentration, history of diabetes and aspirin use, and social class, compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 (95% confidence interval 0.89 to 1.49) for three health behaviours, 1.58 (1.22 to 2.05) for two, 2.18 (1.63 to 2.92) for one, and 2.31 (1.33 to 4.02) for none (P<0.001 for trend). The relations were consistent in subgroups stratified by sex, age, body mass index, and social class, and after exclusion of deaths within two years.

CONCLUSION: Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women.

LanguageEnglish
Article numberb349
JournalBritish Medical Journal (Clinical Research Ed.)
Volume338
StatePublished - 2009

Fingerprint

Health Behavior
Stroke
Population
Neoplasms
Social Class
Body Mass Index
Blood Pressure
Incidence
Vegetables
Aspirin
Ascorbic Acid
Myocardial Infarction
Cholesterol
Alcohols
Confidence Intervals

Keywords

  • Adult
  • Aged
  • Alcohol Drinking
  • Aspirin
  • England
  • Exercise
  • Female
  • Fruit
  • Health Behavior
  • Humans
  • Incidence
  • Life Style
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors
  • Prospective Studies
  • Risk Factors
  • Smoking
  • Stroke
  • Vegetables

Cite this

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title = "Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study",
abstract = "OBJECTIVE: To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community.DESIGN: Population based prospective study (EPIC-Norfolk).SETTING: Norfolk, United Kingdom.PARTICIPANTS: 20,040 men and women aged 40-79 with no known stroke or myocardial infarction at baseline survey in 1993-7, living in the general community, and followed up to 2007.MAIN OUTCOME MEASURE: Participants scored one point for each health behaviour: current non-smoking, physically not inactive, moderate alcohol intake (1-14 units a week), and plasma concentration of vitamin C >or=50 micromol/l, indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from 0 to 4.RESULTS: There were 599 incident strokes over 229,993 person years of follow-up; the average follow-up was 11.5 years. After adjustment for age, sex, body mass index (BMI), systolic blood pressure, cholesterol concentration, history of diabetes and aspirin use, and social class, compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 (95{\%} confidence interval 0.89 to 1.49) for three health behaviours, 1.58 (1.22 to 2.05) for two, 2.18 (1.63 to 2.92) for one, and 2.31 (1.33 to 4.02) for none (P<0.001 for trend). The relations were consistent in subgroups stratified by sex, age, body mass index, and social class, and after exclusion of deaths within two years.CONCLUSION: Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women.",
keywords = "Adult, Aged, Alcohol Drinking, Aspirin, England, Exercise, Female, Fruit, Health Behavior, Humans, Incidence, Life Style, Male, Middle Aged, Platelet Aggregation Inhibitors, Prospective Studies, Risk Factors, Smoking, Stroke, Vegetables",
author = "Myint, {Phyo K} and Luben, {Robert N} and Wareham, {Nicholas J} and Bingham, {Sheila A} and Kay-Tee Khaw",
year = "2009",
language = "English",
volume = "338",
journal = "British Medical Journal (Clinical Research Ed.)",
issn = "0267-0623",

}

TY - JOUR

T1 - Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk)

T2 - British Medical Journal (Clinical Research Ed.)

AU - Myint,Phyo K

AU - Luben,Robert N

AU - Wareham,Nicholas J

AU - Bingham,Sheila A

AU - Khaw,Kay-Tee

PY - 2009

Y1 - 2009

N2 - OBJECTIVE: To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community.DESIGN: Population based prospective study (EPIC-Norfolk).SETTING: Norfolk, United Kingdom.PARTICIPANTS: 20,040 men and women aged 40-79 with no known stroke or myocardial infarction at baseline survey in 1993-7, living in the general community, and followed up to 2007.MAIN OUTCOME MEASURE: Participants scored one point for each health behaviour: current non-smoking, physically not inactive, moderate alcohol intake (1-14 units a week), and plasma concentration of vitamin C >or=50 micromol/l, indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from 0 to 4.RESULTS: There were 599 incident strokes over 229,993 person years of follow-up; the average follow-up was 11.5 years. After adjustment for age, sex, body mass index (BMI), systolic blood pressure, cholesterol concentration, history of diabetes and aspirin use, and social class, compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 (95% confidence interval 0.89 to 1.49) for three health behaviours, 1.58 (1.22 to 2.05) for two, 2.18 (1.63 to 2.92) for one, and 2.31 (1.33 to 4.02) for none (P<0.001 for trend). The relations were consistent in subgroups stratified by sex, age, body mass index, and social class, and after exclusion of deaths within two years.CONCLUSION: Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women.

AB - OBJECTIVE: To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community.DESIGN: Population based prospective study (EPIC-Norfolk).SETTING: Norfolk, United Kingdom.PARTICIPANTS: 20,040 men and women aged 40-79 with no known stroke or myocardial infarction at baseline survey in 1993-7, living in the general community, and followed up to 2007.MAIN OUTCOME MEASURE: Participants scored one point for each health behaviour: current non-smoking, physically not inactive, moderate alcohol intake (1-14 units a week), and plasma concentration of vitamin C >or=50 micromol/l, indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from 0 to 4.RESULTS: There were 599 incident strokes over 229,993 person years of follow-up; the average follow-up was 11.5 years. After adjustment for age, sex, body mass index (BMI), systolic blood pressure, cholesterol concentration, history of diabetes and aspirin use, and social class, compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 (95% confidence interval 0.89 to 1.49) for three health behaviours, 1.58 (1.22 to 2.05) for two, 2.18 (1.63 to 2.92) for one, and 2.31 (1.33 to 4.02) for none (P<0.001 for trend). The relations were consistent in subgroups stratified by sex, age, body mass index, and social class, and after exclusion of deaths within two years.CONCLUSION: Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women.

KW - Adult

KW - Aged

KW - Alcohol Drinking

KW - Aspirin

KW - England

KW - Exercise

KW - Female

KW - Fruit

KW - Health Behavior

KW - Humans

KW - Incidence

KW - Life Style

KW - Male

KW - Middle Aged

KW - Platelet Aggregation Inhibitors

KW - Prospective Studies

KW - Risk Factors

KW - Smoking

KW - Stroke

KW - Vegetables

M3 - Article

VL - 338

JO - British Medical Journal (Clinical Research Ed.)

JF - British Medical Journal (Clinical Research Ed.)

SN - 0267-0623

M1 - b349

ER -