Association between healthy lifestyle and risk of ischemic stroke among elderly adults with hypertension: a cross-sectional study in China

Jian Wu¹Xiaoyu Jiao¹Wenzhe Qi¹Lipei Zhao¹Xinghong Guo¹Nengguang Dai^1,2Rongmei Liu³Qiuping Zhao³Yudong Miao¹Beizhu Ye^1*

• ¹Zhengzhou University College of Public Health, Zhengzhou, China
• ²Health Commission of Henan Province, Zhengzhou, China
• ³Central China Fuwai Hospital of Zhengzhou University Henan Provincial Key Laboratory of Chronic Disease Health Management, Zhengzhou, China

ABSTRACT Introduction While adopting multiple healthy lifestyle behaviors has been shown to significantly reduce the risk of ischemic stroke (IS) in the general adults population, there is limited evidence on whether such benefits extend to older adults with hypertension. This study aimed to examine how a combination of modifiable healthy lifestyle behaviors is associated with the risks of IS among hypertensive patients aged 65 years and older. Methods This population-based study was conducted in Jia County, Henan Province, from July 1 to August 31, 2023. Data on participants' lifestyles was collected through structured, face-to-face interviews. A composite lifestyle score was generated using five modifiable behaviors; non-smoking, non-drinking, ideal sleep duration, adherence to a healthy diet, and engagement in regular physical activity. The relationship between lifestyle and IS was determined by using logistic regression models, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). To identify optimal interaction patterns among multiple factors, we applied generalized multifactor dimensionality reduction (GMDR) analysis. Results A total of 17747 participants were included (42.11% male, mean age 73.39 years), 31.20% of whom had a history of IS. In multivariable-adjusted models, maintaining a healthy diet, abstaining from smoking, getting adequate sleep, and never drinking were each independently associated with a lower risks of IS. There was a clear, inverse relationship between the number of healthy lifestyle behaviors and IS risk. After adjusting for covariates, participants who adopted all five healthy lifestyle behaviors had the lowest prevalence of IS, with a 58.5% reduction compared to those who reported none of the healthy behaviors. For every additional point gained in the healthy lifestyle score, the risk of IS dropped by 11.2%. The GMDR analysis showed that sleep, diet and smoking had the most significant interaction with the risk of IS. Conclusion Embracing healthier lifestyle habits can significantly lower the risk of IS among older adults with hypertension in China. These findings offer valuable guidance for designing targeted lifestyle interventions aimed at preventing stroke in this high-risk population.