Optimal CV health behaviors may mitigate genetic risk for stroke
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Maintaining optimal CV health by following the American Heart Association’s Life’s Simple 7 protected people from stroke, even among those at high genetic risk, data from a long-term analysis show.
In an analysis of data from the Atherosclerosis Risk in Communities study spanning 28 years, researchers found that Black and white adults with a polygenic risk score indicating high risk for stroke lived about 6 years longer when adhering to optimal CV health behaviors, such a following a healthy diet, not smoking and maintaining a healthy weight.
“We know that well-managed, modifiable risk factors, especially treatment of hypertension, can noticeably lower an individual’s risk of stroke,” Myriam Fornage, PhD, FAHA, professor of molecular medicine and human genetics at the Institute of Molecular Medicine at The University of Texas Health Science Center at Houston, said in a press release. “Our study confirmed that we may be able to mitigate the lifetime risk of stroke by modifying other risk factors, and that regardless of genetics — whether you have a high polygenic risk score or low polygenic risk score — maintaining good cardiovascular health decreases the lifetime risk of stroke.”
Fornage and colleagues analyzed data from 11,568 middle-aged adults (56% women; 23% Black) with available genetic and Life’s Simple 7 data who were free of stroke at baseline and followed for a median of 28 years. Researchers estimated lifetime risk for stroke according to levels of genetic risk based on a validated stroke polygenic risk score, and according to levels of CV health based on the AHA’s Life’s Simple 7 recommendations. For each component — total cholesterol, BP, glucose, physical activity, diet, smoking status and BMI — participants were categorized into “poor,” “intermediate” and “ideal” groups.
The findings were published in the Journal of the American Heart Association.
At age 45 years, adults with a high, intermediate and low polygenic risk score had a remaining lifetime risk for stroke of 23.2% (95% CI, 20.8-25.5), 13.8% (95% CI, 11.7-15.8), and 9.6% (95% CI, 7.3-11.8), respectively. Starting at age 45 years, participants with an inadequate, average and optimal Life’s Simple 7 had a remaining long-term risk for stroke of 17.6% (95% CI, 15.6-19.6), 13.4% (95% CI, 11.8-15.1), and 9.8% (95% CI, 7.1-12.5), respectively. Researchers observed that the highest long-term risk for stroke, 24.8%, was observed in adults with both a high genetic risk and an inadequate Life’s Simple 7 score (95% CI, 22-27.6).
Across all polygenic risk score categories, those with an optimal Life’s Simple 7 score had a 30% to 43% lower long-term risk for stroke compared with adults with an inadequate Life’s Simple 7 score. Those with a high polygenic risk score and an inadequate Life’s Simple 7 had the shortest overall survival, a mean of 72.7 years, and the shortest survival free of stroke, a mean of 66.7 years. However, those with a low polygenic risk score and an optimal Life’s Simple 7 had the most extended overall survival and survival free of stroke, a mean of 76.7 years and 74.1 years, respectively.
“This corresponded to almost 6 additional years lived free of stroke,” the researchers wrote.
The researchers wrote that maintaining optimal CV health was associated with the lowest lifetime risk estimates, emphasizing the importance of modifiable risk factors in prevention efforts to reduce stroke risk. However, the researchers cautioned that “considerable improvements” to the stroke polygenic risk score are still needed before clinical utility can be achieved, especially for underrepresented populations.
“However, studies such as ours lay the groundwork toward realizing the potential of personalizing genetic risk information to motivate lifestyle and vascular health changes and prevent stroke,” the researchers wrote.
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