Search tips
Search criteria 


Logo of jepicomhJournal of Epidemiology and Community HealthVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Epidemiol Community Health. 1997 April; 51(2): 138–143.
PMCID: PMC1060435

Lifelong exposures and the potential for stroke prevention: the contribution of cigarette smoking, exercise, and body fat.


STUDY OBJECTIVE: To examine the potential for stroke prevention by avoidance of hazards related to lifestyle. Assessment of the lifelong contribution of both individual and combined exposures was a particular feature of the study. An estimate was sought of the proportion (population attributable risk fraction) of strokes likely to be caused by one or a combination of cigarette smoking, lack of exercise, and obesity. DESIGN: Case-control study. SETTING: Eleven general practices in west Birmingham. PARTICIPANTS: Altogether 125 men and women who had just had their first stroke and were aged 35-74 and 198 controls frequency matched for age and sex recruited over 24 months during 1988-90. MAIN RESULTS: The hazards of cigarette smoking for stroke were confirmed and noted to persist for one to two decades after stopping smoking. Cigarette smoking was estimated to have caused 49% (95% confidence level 22, 67%) of the strokes in this population with roughly equal contributions from current and former smoking. Combinations of cigarette smoking (current and former) with lack of exercise or previous obesity apparently caused 62% and 72% of the strokes respectively. If cigarette smoking, lack of exercise and obesity were all avoided, 79% (32, 94%) of the strokes could potentially have been prevented. No stroke patient reported a combination of never smoking, taking regular exercise aged 15 to 25, and avoidance of overweight (body mass index > 25 kg/m2). CONCLUSIONS: Taken together, the combination of cigarette smoking, excessive body fat, and lack of exercise accounted for a major proportion of stroke cases in the population studied. It appears that these easily identifiable factors related to lifestyle are a major and possibly predominant cause of stroke, at least until the age of 75.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989 Mar 25;298(6676):789–794. [PMC free article] [PubMed]
  • Donnan GA, McNeil JJ, Adena MA, Doyle AE, O'Malley HM, Neill GC. Smoking as a risk factor for cerebral ischaemia. Lancet. 1989 Sep 16;2(8664):643–647. [PubMed]
  • Shaper AG, Phillips AN, Pocock SJ, Walker M, Macfarlane PW. Risk factors for stroke in middle aged British men. BMJ. 1991 May 11;302(6785):1111–1115. [PMC free article] [PubMed]
  • Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Rosner B, Speizer FE, Hennekens CH. Smoking cessation and decreased risk of stroke in women. JAMA. 1993 Jan 13;269(2):232–236. [PubMed]
  • Shinton R, Shipley M, Rose G. Overweight and stroke in the Whitehall study. J Epidemiol Community Health. 1991 Jun;45(2):138–142. [PMC free article] [PubMed]
  • Wannamethee G, Shaper AG. Physical activity and stroke in British middle aged men. BMJ. 1992 Mar 7;304(6827):597–601. [PMC free article] [PubMed]
  • Shinton R, Sagar G. Lifelong exercise and stroke. BMJ. 1993 Jul 24;307(6898):231–234. [PMC free article] [PubMed]
  • Shinton R, Sagar G, Beevers G. Body fat and stroke: unmasking the hazards of overweight and obesity. J Epidemiol Community Health. 1995 Jun;49(3):259–264. [PMC free article] [PubMed]
  • Shinton R, Sagar G, Beevers G. The relation of alcohol consumption to cardiovascular risk factors and stroke. The west Birmingham stroke project. J Neurol Neurosurg Psychiatry. 1993 May;56(5):458–462. [PMC free article] [PubMed]
  • Thompson SG, Greenberg G, Meade TW. Risk factors for stroke and myocardial infarction in women in the United Kingdom as assessed in general practice: a case-control study. Br Heart J. 1989 May;61(5):403–409. [PMC free article] [PubMed]
  • Cook DG, Shaper AG, Pocock SJ, Kussick SJ. Giving up smoking and the risk of heart attacks. A report from The British Regional Heart Study. Lancet. 1986 Dec 13;2(8520):1376–1380. [PubMed]
  • Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA. 1996 May 22;275(20):1571–1576. [PubMed]
  • Paffenbarger RS, Jr, Wing AL. Chronic disease in former college students. XI. Early precursors of nonfatal stroke. Am J Epidemiol. 1971 Dec;94(6):524–530. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group