Monday, July 25, 2016 Study: 10 Modifiable Risk Factors Associated With 90% of Strokes Worldwide Ten modifiable risk factors are associated with 90% of strokes, according to a recently published international study (abstract only available for free). Risk factors include physical inactivity, hypertension, poor diet, obesity, smoking, cardiac causes, diabetes, alcohol use, stress, and increased lipid levels. The case-control study was “phase 2” of the larger INTERSTROKE study. According to lead author Martin McDonnell in a related Lancet podcast, the goals of this study were to describe and quantify stroke risk factors and identify any “regional variations by population characteristics or stroke subtype.” Researchers examined patient data from 142 participating facilities in 32 countries representing all continents (26,919 participants and 13,472 controls). Participants were assessed with a variety of measures, as well as MRI or CT imaging and blood and urine samples, within 5 days of acute first stroke. While all 10 factors were found to be significant overall, their relative importance varied by region. For example, lack of regular physical activity was associated with 59.9% of strokes in China, but was associated with only 4.7% of strokes in Africa. And while waist-to-hip ratio was associated with approximately 37% of strokes in Southeast Asia and Western Europe/North America/Australia, it was associated with only 2.8% of strokes in Eastern and Central Europe and the Middle East. The single constant: hypertension, which researchers determined was the leading cause of stroke in all 6 regions. One unusual finding McDonnell noted was that in South Asia, lower diet quality was actually associated with lower stroke risk. Similarly, higher alcohol intake was associated with a lower stroke risk in Western Europe/North America/Australia, which was not the case with all other regions. Because hypertension was associated with 48% of strokes worldwide, McDonnell asserts, addressing it is the “key to stroke prevention.” Authors hope the results can “support the development of both global and region-specific programs to prevent stroke." APTA offers multiple resources on the role physical therapists (PTs) and physical therapist assistants play in addressing prevention and wellness, including a 2-part podcast on the inactivity epidemic (part 1, part 2) and a recorded presentation on physical activity and the PT. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.