title: Healthy lifestyle and the risk of stroke in women.
abstract: BACKGROUND
  Healthy lifestyle has been associated with decreased risk of coronary heart disease. In contrast, little is known about its association with stroke risk.
  
  
  METHODS
  This is a prospective cohort study among 37 636 women 45 years or older participating in the Women's Health Study. Stroke was self-reported and confirmed by means of medical record review. We considered the following self-reported lifestyle factors: smoking, alcohol consumption, exercise, body mass index, and diet. The health index was calculated from these variables by assigning scores from 0 to 4 to the respective variable categories, with a higher score indicating healthier behavior. Healthy behavior was defined as never smoking, alcohol consumption between 4 and 10.5 drinks per week, exercise 4 or more times per week, body mass index (calculated as weight in kilograms divided by the square of height in meters) less than 22, and a diet high in cereal fiber, folate, and omega-3 fatty acids, with a high ratio of polyunsaturated to saturated fat, and low in trans fat and glycemic load.
  
  
  RESULTS
  During 10 years of follow-up, 450 strokes (356 ischemic, 90 hemorrhagic, and 4 undefined) were confirmed. Compared with participants with 0 to 4 health index points (4.3%), women with 17 to 20 health index points (4.7%) had multivariable-adjusted hazard ratios (95% confidence interval) of 0.45 (0.24-0.83; P<.001 for trend) for total stroke, 0.29 (0.14-0.63; P<.001 for trend) for ischemic stroke, and 1.27 (0.37-4.29; P = .62 for trend) for hemorrhagic stroke.
  
  
  CONCLUSIONS
  In this large prospective cohort of apparently healthy women, a healthy lifestyle consisting of abstinence from smoking, low body mass index, moderate alcohol consumption, regular exercise, and healthy diet was associated with a significantly reduced risk of total and ischemic stroke but not of hemorrhagic stroke. Our findings underscore the importance of healthy behaviors in the prevention of stroke.
authors.affiliation: Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. tkurth@rics.bwh.harvard.edu
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
authors.forename: Steven C
authors.initials: SC
authors.lastname: Moore
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Kase
authors.forename: Meir J
authors.initials: MJ
authors.lastname: Stampfer
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D004032:Diet; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology