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Combined lifestyle factors are associated with the risk of ischaemic stroke in a Chinese population
  1. Tao You1,
  2. Yi Li1,
  3. Xiaoguang Wu1,
  4. Siyi Wu1,
  5. Yanlin Zhang2,
  6. Xiang Zhou1
  1. 1Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  2. 2Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  1. Correspondence to Dr Xiang Zhou, Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China; zhou-xiang{at}


Purpose Lifestyle plays an important role in the development of ischaemic stroke (IS). The objective of this study was to evaluate the association between combined lifestyle factors and the risk of IS in an eastern Chinese population.

Methods We collected lifestyle information from 191 patients with IS admitted to the second affiliated hospital of Soochow University and 575 control subjects from community clinics using a structured questionnaire. After division into training and test datasets, regularised stepwise logistic regression, least absolute shrinkage and selection operator regression and genetic algorithm models were used to identify lifestyle factors associated with IS. The improved discriminative ability by adding the lifestyle factors was determined by c-index and reclassification analysis. The final model was validated in the test dataset.

Results After controlling for conventional cardiovascular disease (CVD) risk factors, preferences for fruits (OR (95% CI): 0.29 (0.18–0.46), p<0.001) and soy products (0.47 (0.29–0.75), p=0.002) were negatively associated with IS, while lower life satisfaction (mildly satisfied: 2.15 (1.27–3.63), p=0.004; not satisfied: 6.39 (1.76–25.44), p=0.006) was positively associated with IS. Adding these factors to a basic CVD risk model improved the c-index (0.825 vs 0.753, p<0.001) and reclassification for IS (net reclassification index (95% CI): 18.49% (7.90%–29.08%), integrated discrimination index (95% CI): 0.11% (0.08%–0.14%), p<0.001). The model with lifestyle factors achieved a c-index of 0.813 and good calibration in the test dataset.

Conclusions Our results showed that combined lifestyle factors including dietary pattern and life satisfaction are independently associated with the risk of IS.

  • stroke
  • risk management
  • epidemiology

Statistics from


  • TY and YL contributed equally.

  • Contributors TY, YL, XW, SW and YZ performed the study and wrote the manuscript. TY and YL carried out the statistical analysis. XZ designed the study and revised the manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China (grant number 81900140); Young Investigator Pre‐Research Foundation of the Second Affiliated Hospital of Soochow University (grant number SDFEYQN1717) and Jiangsu Young Medical Talents Project (grant number qnrc2016871).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocols are conformed to the Declaration of Helsinki and was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University. Written informed consent was obtained from each participant or their immediate relatives.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified participant data are available upon reasonable request from the corresponding author.

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