Supplementary Material for: Association between Physical Activity and Risk of Stroke Subtypes: The Atherosclerosis Risk in Communities Study

Background: The relationship between stroke subtypes and physical activity is unclear. Methods: Using data from 13,069 men and women aged 45–64 years who participated in the Atherosclerosis Risk in Communities Study, physical activity was assessed by self-report using the Baecke questionnaire at baseline (1987–1989). The American Heart Association’s ideal cardiovascular health guidelines served as a basis for the calculation of three physical activity categories: poor, intermediate, and ideal. Stroke and its subtypes were ascertained from physician review of medical records. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models. Results: During a median follow-up of 18.8 years, a total of 648 incident ischemic strokes occurred. Significant inverse associations were found between physical activity categories and total, total ischemic, and nonlacunar stroke in adjusted models (age, sex, race-center, education, cigarette-years). Compared with poor physical activity, the adjusted HR (95% CI) for ideal physical activity were 0.78 (0.62–0.97) for total, 0.76 (0.59–0.96) for total ischemic, 0.85 (0.51–1.40) for lacunar, 0.77 (0.47–1.27) for cardioembolic, and 0.71 (0.51–0.99) for nonlacunar stroke. Additional adjustments for waist-to-hip ratio, systolic blood pressure, antihypertensive medication, diabetes, left ventricular hypertrophy and laboratory parameters attenuated the HR. Further sex- and race-specific analyses revealed that the association was predominantly observed among males and among African-Americans. Conclusion: These data suggest a tendency toward a reduced risk of total, total ischemic, and nonlacunar stroke with higher levels of physical activity.

背景：脑卒中亚型与体力活动之间的关系尚不明确。方法：利用来自13,069名45至64岁男性和女性的动脉粥样硬化风险社区研究数据，通过Baecke问卷在基线（1987-1989年）进行体力活动自我报告评估。以美国心脏协会的理想心血管健康指南为基础，计算了三种体力活动类别：不良、中等和理想。通过医师对病历的审查确定脑卒中和其亚型。使用多变量调整后的风险比（HR）和95%置信区间（CI）计算Cox回归模型来评估。结果：在平均随访18.8年的过程中，共发生648例新发缺血性脑卒中。在调整模型（年龄、性别、种族-中心、教育、吸烟年数）中，发现体力活动类别与总体、总体缺血性以及非腔隙性脑卒之间存在显著的负相关关系。与不良体力活动相比，调整后的风险比（95%置信区间）对于理想体力活动分别为总体0.78（0.62-0.97）、总体缺血性0.76（0.59-0.96）、腔隙性0.85（0.51-1.40）、心源性0.77（0.47-1.27）以及非腔隙性脑卒中0.71（0.51-0.99）。对腰臀比、收缩压、抗高血压药物、糖尿病、左心室肥厚和实验室参数的进一步调整削弱了风险比。进一步的性别和种族特异性分析显示，这种关联主要存在于男性以及非洲裔美国人中。结论：这些数据表明，随着体力活动水平的增加，总体、总体缺血性和非腔隙性脑卒中的风险呈现降低趋势。