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Physical health-related quality of life predicts stroke in the EPIC-Norfolk

From the Department of Public Health and Primary Care (P.K.M., P.G.S., N.W.J.W., R.N.L., A.A.W., K.-T.K.), University of Cambridge; MRC Centre for Nutrition and Cancer (S.A.B.), Cambridge; and MRC Epidemiology Unit (N.J.W.), Elsie Widdowson Laboratories, Cambridge, UK.

Address correspondence and reprint requests to Dr. Phyo Kyaw Myint, Clinical Gerontology Unit, Level 2, F&G Block, Box-251, Addenbrooke’s University Hospital, Hills Road, Cambridge, CB2 2QQ UK Pkyawmyint{at}aol.com

Objective: To examine the relationship between Short Form (SF)-36 physical functional health-related quality of life and incident stroke.

Methods: A total of 13,615 men and women participating in the European Prospective Investigation into Cancer–Norfolk who were free of stroke, myocardial infarction, and cancer at baseline were included in the study. Participants completed a health and lifestyle questionnaire and attended a health examination during 1993 to 1997. Self-reported physical functional health was assessed using physical component summary scores of SF-36 18 months later. Stroke incidence was ascertained by death certification and hospital record linkage up to 2005.

Results: There were 244 incident strokes (total person years = 99,191). People who reported better physical functional health had significantly lower risk of incident stroke. Using Cox proportional hazard models adjusting for age, sex, body mass index, systolic blood pressure, cholesterol, smoking, diabetes, physical activity, social class, alcohol consumption, and respiratory function, men and women who were in the top quartile of SF-36 physical component summary scores had half the risk of stroke (RR = 0.50 [0.31, 0.78]) compared to the people in the bottom quartile. The relationships remained unchanged after excluding strokes occurring within the first 2 years of follow-up.

Conclusions: Physical functional health-related quality of life measured as Short Form-36 predicts subsequent stroke risk independently of known risk factors in a general population. Poor physical functional health may indicate a high-risk population for stroke who may benefit most from targeted preventive interventions such as management of known risk factors.

Abbreviations: BMI = body mass index; BP = blood pressure; EPIC = European Prospective Investigation into Cancer; FEV1 = forced expiratory volume in 1 second; PCS = physical component summary; RR = relative risk; SF = Short Form.

Supplemental data at www.neurology.org

European Prospective Investigation into Cancer (EPIC)–Norfolk is supported by research program grant funding from Cancer Research UK and the Medical Research Council with additional support from the Stroke Association, British Heart Foundation, Department of Health, Research Into Ageing, and Academy of Medical Sciences.

Disclosure: The authors report no conflicts of interest.

Received January 11, 2007. Accepted in final form June 5, 2007.