A healthy lifestyle can offset a high genetic risk for stroke

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. 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." Fornage is The Laurence and Johanna Favrot Distinguished Professor in Cardiology at McGovern Medical School at UTHealth Houston.

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.

People in the 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.

Co-authors from UTHealth Houston were Nitesh Enduru, MPH; a graduate research assistant with UTHealth Houston School of Biomedical Informatics; and Eric Boerwinkle, PhD, dean of UTHealth School of Public Health. Other contributors were Adrienne Tin, PhD; Michael E. Griswold, PhD; and Thomas H. Mosley, PhD, from the University of Mississippi in Jackson, Mississippi; and Rebecca F. Gottesman, MD, PhD, from the National Institute of Neurological Disorders and Stroke (NINDS). First author of the paper was Emy A. Thomas, formerly with UTHealth Houston.

Fornage and Boerwinkle are also members of The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences.

The study was funded by the NINDS (including grants U19-NS120384 and UH3-NS100605), part of the National Institutes of Health.