Association Between A Lifestyle Medicine Score And Stroke In U.S. Adults With Hyperglycemia: 2007-2010 NHANES

The relationship between glycemic control and cardiovascular disease (CVD) is well established, however, lifestyle modifications to prevent CVD warrant further investigation. PURPOSE: This study aimed to evaluate the relationship between adherence to the six lifestyle medicine pillars promoted by the American College of Lifestyle Medicine and stroke in U.S. adults with hyperglycemia. A lifestyle medicine composite score (LMS) was developed to quantify adherence with the hypothesis that a higher LMS (greater adherence to lifestyle recommendations) correlates with lower odds of stroke in adults with hyperglycemia. METHODS: The study sample (n = 2,079) included adult (≥ 40 years of age) participants in the 2007-2010 National Health and Nutrition Examination Survey. LMS was based on six pillars of lifestyle medicine (i.e., nutrition, physical activity, stress management, restorative sleep, social connection, avoidance of risky substances [tobacco, excessive alcohol]). Weighted multivariate logistic regression analysis was conducted to assess the impact of the LMS on the odds of having a stroke, adjusting for age, race, education, BMI, total cholesterol, and hypertension. The LMS composite score was included both as a continuous (raw score) and a categorical (greater or equal to 3 vs. less than 3) to check the robustness of the results. RESULTS: In U.S. adults with hyperglycemia, our data suggest that for every 1-point increase in LMS, the odds are 14% (odds ratio [OR] 0.861; 95% confidence interval [CI] 0.860, 0.862) lower for reporting a stroke. Our findings also illustrate 29% (OR 0.714; 95% CI 0.712, 0.716) lower odds of reporting a stroke in those with hyperglycemia and reporting adherence to three or more of the lifestyle medicine pillars. CONCLUSIONS: This study supports the hypothesis that a greater LMS is associated with lower odds of stroke in individuals with hyperglycemia. Greater adherence to lifestyle medicine pillars appears beneficial in reducing the odds of reporting a stroke in U.S. adults with hyperglycemia. Promoting lifestyle changes as part of a preventive medicine approach to health should help reduce the chronic disease burden while improving overall quality of life.