Stroke risk in older men and women: aspirin, estrogen, exercise, vitamins, and other factors

To identify risk factors and preventive measures for stroke in elderly men and women.

Observational prospective cohort study.

Women (N = 8532) and men (N = 4722) between the ages of 44 and 101 (median age, 74) residing in a retirement community in southern California who had no previous history of stroke.

Upon entering the study in 1981, 1983, or 1985, study participants filled out a detailed health survey questionnaire about their medical history, exercise habits, intake of caffeinated beverages, alcohol, vitamins, and foods containing vitamins A or C, and history of smoking. Women also reported their use of estrogen replacement therapy. Cohort members were followed by periodic resurvey and by examination of death records through 1998. Age-adjusted stroke incidence rates, relative risks, and 2-sided P values were calculated.

Between 1981 and 1998, 1211 women and 773 men were hospitalized for cerebrovascular disease. In women, risk of cerebral occlusion decreased significantly with increasing duration and recency of estrogen use. Hypertension, diabetes, heart attack, and smoking were significant stroke risk factors in both women and men. Exercise reduced stroke risk in general, and antioxidant vitamin supplements decreased the risk of cerebral occlusion.

These results emphasize the role of lifestyle modification in the primary prevention of stroke and suggest that estrogen replacement therapy may be a potential preventive measure for women.