Lifestyle risk factors and stroke: findings from the national health and nutrition examination survey (1999–2020) and a Mendelian randomization analysis

This study aimed to assess the relationship between lifestyle risk factors and stroke, as well as to quantify causality, using data from the National Health and Nutrition Examination Survey (NHANES) and Mendelian randomization (MR). We analyzed data from 28,226 individuals who participated in NHANES between 1999 and 2020. To evaluate the association between lifestyle risk factors and stroke, we used weighted multivariate logistic regression. Genome-wide association study (GWAS) summary data were utilized to conduct bidirectional two-sample MR and multivariate MR analyses. The NHANES observational study found that waist circumference, smoking, and creatinine were consistently and positively associated with stroke in multivariable-adjusted models, with odds ratios (OR) of 1.010 (95% confidence interval [CI], 1.001–1.019, p = 0.046), 1.653 (95% CI, 1.310–2.084, p p p = 0.037). Bidirectional two-sample and multivariate MR analyses revealed a causal link between smoking, waist circumference, and stroke (OR = 1.237, 95% CI, 1.130–1.354; OR = 1.239, 95% CI, 1.149–1.335, respectively). Vigorous activities, especially fitness and recreational activities, serve as a protective factor against stroke. Smoking and increased waist circumference represent consistent lifestyle-related risk factors for stroke.

本研究旨在利用美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）与孟德尔随机化（Mendelian randomization, MR）数据，评估生活方式危险因素与脑卒中的关联，并量化其因果效应。我们分析了1999年至2020年间参与NHANES的28226名个体的数据。为评估生活方式危险因素与脑卒中的关联，我们采用加权多变量logistic回归分析。本研究借助全基因组关联研究（Genome-wide association study, GWAS）汇总数据，开展双向两样本MR及多变量MR分析。NHANES观察性研究结果表明，在多变量校正模型中，腰围、吸烟与肌酐水平均与脑卒中呈持续正相关，其比值比（odds ratios, OR）分别为1.010（95%置信区间（confidence interval, CI）：1.001~1.019，P=0.046）、1.653（95%CI：1.310~2.084，P=0.037）。双向两样本MR与多变量MR分析结果显示，吸烟、腰围增大与脑卒中存在因果关联（OR分别为1.237，95%CI：1.130~1.354；1.239，95%CI：1.149~1.335）。高强度体力活动，尤其是健身与休闲活动，可作为脑卒中的保护性因素。吸烟与腰围增大是与脑卒中相关的持续生活方式危险因素。