By Lisa Rapaport

(Reuters Health) – Stroke survivors are doing better at managing their blood pressure and cholesterol today than a generation ago, but a growing number now have poor eating and exercise habits that carry a risk of repeat strokes, a small U.S. study suggests.

To minimize the risk of another stroke, the American Heart Association (AHA) recommends seven key things: not smoking, getting regular exercise, maintaining a healthy weight, keeping blood pressure, cholesterol and blood sugar in check, and eating a diet rich in whole grains, fruits, vegetables and lean protein with limited sweets and fats.

For the study, researchers followed 1,597 stroke survivors who participated in nationwide health surveys from 1988 to 2014. During this time, the proportion of stroke survivors who achieved no more than one of these recommendations increased from 18 percent to 34 percent.

“Notably, we found that treatment of blood pressure, cholesterol and blood sugar has improved with time,” said senior study author Dr. Amytis Towfighi of the Los Angeles County+USC Medical Center in California.

“However, we also saw that obesity has increased, physical activity has decreased, and diet has worsened,” Towfighi said by email. “These findings suggest that we are better at controlling risk factors that can be treated with medications, but we are not faring well with respect to lifestyle factors that are harder to control as they entail behavioral changes.”

Change, even aided by medication, isn’t easy. Just one person in the entire study managed to achieve all seven recommendations for minimizing the risk of another stroke.

People did do better with recommendations that could be achieved with prescription drugs like lowering blood pressure and cholesterol levels, the researchers report in Stroke.

The proportion of participants with poorly controlled blood pressure fell from 45 percent to 27 percent during the study, while the proportion with high cholesterol dropped from 37 to 10 percent.

At the same time, the proportion of participants with obesity rose from 27 to 39 percent, while the proportion who got no exercise at all surged from 45 to 71 percent and the proportion with poor diets climbed from 14 to 51 percent.

Some participants had a harder time achieving all of the recommendations than others. People without any education beyond high school, for example, were four times more likely to miss most of the recommendations than individuals with at least some college. Both poor and black people in the study were more than twice as likely to miss most of the recommendations than more affluent participants or people from other racial and ethnic groups.

The study wasn’t designed to prove whether or how achieving goals set by the AHA for optimal cardiovascular health might directly help prevent strokes or improve longevity. One limitation is that it relied on survey data that might not accurately reflect how well people did at managing conditions like diabetes or obesity or adopting healthy eating and exercise habits.

Even so, other research has demonstrated the benefits of following these recommendations, said Dr. Khurram Nasir of Yale University in New Haven, Connecticut, who wasn’t involved in the study.

“There is convincing evidence that favorable cardiovascular health protects from cardiovascular disease, cardiovascular disease mortality and all-cause mortality,” Nasir said by email.

“It also appears that the benefits of favorable cardiovascular health extend beyond cardiovascular disease prevention to disorders including cancer, depression and cognitive impairment,” Nasir added.

For patients, the study results should offer an incentive to start or stick with prescribed medications for managing blood pressure, cholesterol and diabetes, said Dr. Michael Hill of the University of Calgary and Foothills Medical Centre in Canada.

And, patients should also take a fresh look at their lifestyle habits, Hill, who wasn’t involved in the study, said by email.

“There’s still lots to do to optimize health,” Hill said. “Get up off the couch and ditch the chips.”

SOURCE: Stroke, online December 7, 2018.