Evid Based Nurs 12:120 doi:10.1136/ebn.12.4.120
  • Causation

A combination of 4 health behaviours was associated with increasing risk of stroke


Does the combined effect of 4 health behaviours (smoking, physical activity, alcohol use, and fruit and vegetable intake) affect the risk of stroke in community-dwelling people?



cohort study with a mean 11.5-year follow-up (Norfolk component of the European Prospective Investigation of Cancer [EPIC-Norfolk]).


general practices in the UK.


20 040 people who were 40–79 years of age (mean age 58 y, 55% women) with no known myocardial infarction or stroke.

Risk factors:

smoking, physical activity, alcohol consumption, and fruit and vegetable intake. Participants were assigned 1 point each for being a non-smoker, being physically active, consuming alcohol moderately (1–14 units/wk), and consuming ⩾5 servings of vegetables and fruit per day (blood concentration of vitamin C ⩾50 μmol/l).


incident stroke (hospital record linkage and death certificate data). Results were adjusted …

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