People who may be stroke-prone because of genetics can lower their risk by as much as 43% by adopting a healthy cardiovascular lifestyle, according to new research led by UTHealth Houston, which was published today in the Journal of the American Heart Association.
The study included 11,568 adults from ages 45 to 64 who were stroke-free at baseline and followed for a median of 28 years. Study participants included 56% women and 23% Black adults, all of who were free of stroke at baseline. The remaining long term risk of stroke was estimated according to levels of genetic risk based on a validated stroke polygenic score.
The levels of cardiovascular health were based on the American Heart Association’s Life’s Simple 7 recommendations, which include stopping smoking, eating better, getting activity, losing weight, managing blood pressure, controlling cholesterol, and reducing blood sugar.
The lifetime risk of stroke was computed according to what is called a stroke polygenic risk score, with people who had more genetic risk factors linked to the risk of stroke scoring higher.
“Our study confirmed that modifying lifestyle risk factors, such as controlling blood pressure, can offset a genetic risk of stroke,” said Myriam Fornage, PhD, senior author and professor of molecular medicine and human genetics at the Institute of Molecular Medicine at UTHealth Houston.
“We can use genetic information to determine who is at higher risk and encourage them to adopt a healthy cardiovascular lifestyle, such as following the AHA’s Life’s Simple 7, to lower that risk and live a longer, healthier life,” she added. Fornage is The Laurence and Johanna Favrot Distinguished Professor in Cardiology at McGovern Medical School at UTHealth Houston.
In this study, across all polygenic risk score categories, those with an optimal Life’s Simple 7 had approximately 30% to 43% lower life time risk of stroke than those with an inadequate Life’s Simple 7. This corresponded to almost 6 additional years lived free of stroke.
Each year, 795,000 people in the U.S. suffer a stroke, according to the Centers for Disease Control and Prevention. That equates to someone having a stroke every 40 seconds, and someone dies from a stroke every 3.5 minutes.
Stroke is a leading cause of long-term serious disability with stroke reducing mobility in more than half of stroke survivors age 65 and older. But stroke also occurs in younger adults—in 2014, 38% of people hospitalized for stroke were less than 65 years old. Many efforts are underway to find biomarkers that will help identify people at higher risk of stroke or recurrence.
People in this study who scored the highest for genetic risk of stroke and the poorest for cardiovascular health had the highest lifetime risk of having a stroke at 25%. Regardless of the level of genetic risk of stroke, those who had practiced optimal cardiovascular health lowered that risk by 30% to 45%. That added up to nearly six more years of life free of stroke.
Overall, people with a low adherence to Life’s Simple 7 suffered the most stroke events (56.8%) while those with a high adherence had 71 strokes (6.2%).
A limitation of the paper is the polygenic risk score has not been validated broadly, so its clinical utility is not optimal, particularly for people from diverse racial or ethnic backgrounds.
