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

*Corresponding author for this work

Research output: Contribution to journalArticle

92 Citations (Scopus)

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 >= 50 mu mol/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

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

Original languageEnglish
Article numberb349
Number of pages7
JournalBritish Medical Journal
Volume338
DOIs
Publication statusPublished - 19 Feb 2009

Keywords

  • physical-activity questionnaire
  • coronary heart-disease
  • myocardial-infarction
  • cardiovascular-disease
  • cigarette-smoking
  • vitamin-C
  • mortality
  • repeatability
  • validity
  • markers

Cite this

@article{d5a3bfea38c947519b0de6816a8c34b5,
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 >= 50 mu mol/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 (PConclusion Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women.",
keywords = "physical-activity questionnaire, coronary heart-disease, myocardial-infarction, cardiovascular-disease, cigarette-smoking, vitamin-C, mortality, repeatability, validity, markers",
author = "Myint, {Phyo K.} and Luben, {Robert N.} and Wareham, {Nicholas J.} and Bingham, {Sheila A.} and Kay-Tee Khaw",
year = "2009",
month = "2",
day = "19",
doi = "10.1136/bmj.b349",
language = "English",
volume = "338",
journal = "BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

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 - prospective population study

AU - Myint, Phyo K.

AU - Luben, Robert N.

AU - Wareham, Nicholas J.

AU - Bingham, Sheila A.

AU - Khaw, Kay-Tee

PY - 2009/2/19

Y1 - 2009/2/19

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 >= 50 mu mol/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 (PConclusion 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 >= 50 mu mol/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 (PConclusion Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women.

KW - physical-activity questionnaire

KW - coronary heart-disease

KW - myocardial-infarction

KW - cardiovascular-disease

KW - cigarette-smoking

KW - vitamin-C

KW - mortality

KW - repeatability

KW - validity

KW - markers

U2 - 10.1136/bmj.b349

DO - 10.1136/bmj.b349

M3 - Article

VL - 338

JO - BMJ

JF - BMJ

SN - 0959-8146

M1 - b349

ER -