Stroke is a major cause of mortality globally and its incidence rises sharply with age. In the United Kingdom, more than $30 billion are spent annually on stroke care and stroke-related disability. With more adults surviving to older ages, this burden is likely to increase. Research exploring the utility of cardiovascular health and it’s Life’s Simple 7 components for prevention of stroke in older adults is limited. Prospective associations of LS7 metrics and composite CVH were made in the British Regional Heart Study.

Cox models estimated hazard ratios of stroke for ideal and intermediate versus insufficient levels of LS7; composite CVH scores; and 4 CVH trajectory groups (high-high, high-low, low-high, low-low) derived by dichotomizing CVH scores from each time point across the median value. Population attributable fractions measured the impact of LS7. At a 20-year follow-up only BP displayed an association. At baseline, healthier levels of BP, physical activity, and smoking were associated with reduced stroke risk. Hazard ratios for ideal and intermediate levels of BP 0.40 and 0.65 at baseline; and 0.57 and 0.84 at 20-year follow-up. Associations of CVH scores weakened, and the population’s attributable fractions of LS7 reduced, from middle to old; attributable population fraction of nonideal BP decreased from 53% to 39%.

In conclusion, CVH is weakly associated with stroke at older ages, except for blood pressure. The stroke prevention strategies should prioritize blood pressure control and energize efforts beyond risk factors to manage and detect broader causes, including AF.