Hypertension, current smoking, abdominal obesity, poor diet, and lack of regular physical activity account for more than 80% of the global risk of all stroke (both ischemic and intracerebral hemorrhagic). Adding poor ratio of good-to-bad blood lipids, diabetes, alcohol intake, stress and depression, and heart disorders to the list ups the population attributable risks (PARs) to 90%.

“Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke,” affirm the investigators participating in the international INTERSTROKE study, in which data were collected from 3,000 people in 22 countries who had suffered a first stroke (78% ischemic; 22% intracerebral hemorrhagic) and 3,000 controls (Lancet. 2010;376:112-123).

The analysis revealed the following:

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  • Hypertension was the most important risk factor for all stroke subtypes but was particularly significant in intracerebral hemorrhagic stroke and in people up to age 45 years.
  • Stroke risk was associated much more strongly with waist-to-hip ratio than with BMI.
  • Former smoking was associated with a reduced risk of stroke compared with never smoking. “Even if this apparent reduced risk is not real, the finding suggests that risk rapidly reduces after stopping smoking, indicating that smoking cessation is an essential component for any stroke prevention [program],” explained the researchers. They also noted a dose-response association for number of cigarettes smoked per day, especially for ischemic stroke.
  • Fish and fruit intake was associated with the greatest diet-related reduction in stroke risk; vegetable intake did not appear to play a role.
  • Alcohol intake appears to be a greater contributor to intracerebral hemorrhagic stroke than to ischemic stroke.