Cardiovascular health and stroke risk in older British men

  • Ahmed A & al.
  • Stroke
  • 11 Sep 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Blood pressure (BP), physical activity (PA) and smoking at baseline were associated with stroke in middle age, but only BP showed a clear inverse association with stroke in later life.

Why this matters

  • Stroke prevention strategies for older adults should prioritise BP control and focus beyond traditional risk factors.

Study design

  • This prospective analysis evaluated the associations and impact of cardiovascular health (CVH) and its component Life’s Simple 7 (LS7) metrics (body mass index, BP, glucose, cholesterol, PA, smoking and diet) on stroke burden during middle and older ages in men without cardiovascular disease using data from the British Regional Heart Study.
  • Funding: None disclosed.

Key results

  • At baseline (1978-1980; n=7274; mean age, 50 years), healthier levels of BP, PA, and smoking status were associated with a decreased risk of stroke.
  • Compared with poor levels, adjusted HRs (aHRs; 95% CI) for intermediate and ideal levels were:
    • 0.65 (0.52-0.81) and 0.40 (0.24-0.65) for BP;
    • 0.79 (0.58-1.08) and 0.63 (0.45-0.88) for PA; and
    • 0.69(0.56-0.86) and 0.59 (0.45-0.78) for smoking, respectively.
  • At 20 years follow-up (Q20; n=3798; mean age, 69 years), BP was the only LS7 metric showing an association with subsequent stroke.
  • Compared with poor BP, aHRs (95% CI) for intermediate and ideal levels were 0.84 (0.67-1.05) and 0.57 (0.36-0.90), respectively.
  • Each unit increase in composite CVH score was associated with a lower risk of stroke at baseline (aHR, 0.84; 95% CI, 0.79-0.89) and Q20 (aHR, 0.95; 95% CI, 0.90-1.01).
  • From baseline to Q20, low-high vs low-low CVH trajectory was associated with a reduced risk of stroke (aHR, 0.60; 95% CI, 0.44-0.83).
  • Population attributable fraction of non-ideal BP reduced from 53% in middle age to 39% in older age.


  • Study may have limited generalisability to women and wider British population groups.