Methodological considerations and differences according to sex and stroke subtypes

doi:10.1136/bmj.b1305

Published 31 March 2009, doi:10.1136/bmj.b1305
Cite this as: BMJ 2009;338:b1305

Letters

Lifestyle habits and risk of stroke

Methodological considerations and differences according to sex and stroke subtypes

The first 150 words of the full text of this article appear below.

The finding reported by Myint et al that lifestyle habits havebeneficial effects on stroke occurrence is very reassuring andsupport previous results of large scale, US based cohort studies.¹² ³ Several points merit further comment.

Firstly, while the authors show several multivariable models,their main relative risk estimates come from a model that alsocontrolled for body mass index, systolic blood pressure, andcholesterol concentration. These factors are, however, stronglyinfluenced by lifestyle habits and can be considered potentialmediators of the association between lifestyle habits and stroke.In addition, controlling for potential direct consequences ofexposure may lead to biased effect estimates.⁴ Lifestyle habitsmay thus have an even stronger influence on stroke occurrence.

Secondly, the association between lifestyle habits and riskof stroke in the study is magnified in women. Compared withmen who have a combination of all four lifestyle habits, womenseem to achieve a similar . . . [Full text of this article]

Tobias Kurth, senior researcher

¹ INSERM Unit 708—Neuroepidemiology, 75651 Paris Cedex, France

tobias.kurth@upmc.fr

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