title: Prestroke factors associated with poststroke mortality and recovery in older women in the Women's Health Initiative.
abstract: OBJECTIVE
  To examine prestroke lifestyle factors associated with poststroke mortality and recovery in older women.
  
  
  METHODS
  Longitudinal prospective cohort study.
  
  
  METHODS
  The Women's Health Initiative (WHI, clinical trials and observational study), 40 clinical centers in the United States.
  
  
  METHODS
  WHI participants, women aged 50 to 79, who were stroke-free at baseline (1993/98), with incident stroke before 2005.
  
  
  METHODS
  Participants were followed for mortality through 2010. Prestroke characteristics were from the last examination before the stroke event. Annual follow-up for clinical events ascertained hospitalization for stroke that was subsequently physician adjudicated with medical records. Multivariable regression models were used to analyze factors associated with poststroke mortality and poststroke recovery at hospital discharge (poststroke Glasgow score), adjusting for stroke type.
  
  
  RESULTS
  Of 3,173 women with incident stroke, 1,111 (35%) died. Individuals who were overweight or obese before stroke had lower poststroke mortality than those who were normal weight (obese: hazard ratio (HR) = 0.69, 95% confidence interval (CI) = 0.53-0.88; overweight: HR = 0.72, 95% CI = 0.58-0.90); individuals who were underweight before stroke had nonsignificantly greater poststroke mortality (HR = 2.02, 95% CI = 0.98-4.16, P = .06). Other prestroke factors associated with poststroke mortality included diabetes mellitus (HR = 1.28, 95% CI = 1.01-1.64), current smoking (vs nonsmoker, HR = 2.13, 95% CI = 1.53-3.00), physical inactivity (vs >150 min of exercise per week, HR = 1.39, 95% CI = 1.09-1.78), and lowest physical function quartile (vs highest, HR = 1.54, 95% CI = 1.18-2.02). Prestroke diabetes mellitus was associated with lower odds of good recovery after stroke (odds ratio (OR) = 0.60, 95% CI = 0.44-0.82). Current hormone use before stroke was associated with greater odds of moderate than of severe disability after stroke (OR = 1.29, 95% CI = 1.00-1.66).
  
  
  CONCLUSIONS
  Potentially modifiable factors before stroke, including smoking, diabetes mellitus, and being underweight, were associated with greater poststroke mortality in older women. Being overweight or obese and physical activity before stroke were associated with lower poststroke mortality in older women.
authors.affiliation: Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817, USA. bellcl@hawaii.edu
authors.forename: Christina L
authors.initials: CL
authors.lastname: Bell
authors.forename: Andrea
authors.initials: A
authors.lastname: LaCroix
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
authors.forename: Erinn M
authors.initials: EM
authors.lastname: Hade
authors.forename: Todd
authors.initials: T
authors.lastname: Manini
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Mysiw
authors.forename: Jess David
authors.initials: JD
authors.lastname: Curb
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wassertheil-Smoller
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D003920:Diabetes Mellitus / Q000401:mortality; D004185:Disability Evaluation; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000401:mortality; D016017:Odds Ratio; D050177:Overweight / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D020521:Stroke / Q000401:mortality*; D000071939:Stroke Rehabilitation; D016019:Survival Analysis; D013851:Thinness / Q000401:mortality
keywords: BMI; diabetes mellitus; mortality; recovery; stroke; women