Changes in lifestyle risk factors among stroke survivors

Purpose: Stroke survivors remain at risk of recurrent stroke and cardiovascular events. Lifestyle risk factor modification is central to secondary prevention, yet changes across multiple risk factors after stroke remain poorly characterized. We evaluated changes in lifestyle risk factors among stroke survivors.Methods: Using the Korean National Health Insurance Service database, we conducted a population-based cohort study comparing changes in smoking, alcohol consumption, regular physical activity, and obesity status between 120,874 stroke survivors and 209,348 participants without stroke. We further stratified stroke survivors by the presence and severity of post-stroke disability.Results: Compared with participants without stroke, stroke survivors had higher rates of smoking cessation (54.5% vs. 22.9%) and alcohol cessation (51.0% vs. 21.3%). Nevertheless, 45.5% of those who smoked before stroke continued smoking, and 49.0% of those who consumed alcohol before stroke continued drinking. Stroke survivors were less likely to maintain regular physical activity than participants without stroke (38.1% vs. 43.8%). Stroke survivors with severe disability had the lowest rates of maintaining (29.1%) or initiating (12.7%) regular physical activity. Changes in obesity status were more frequent among stroke survivors in both directions: from obesity to non-obesity (20.6% vs. 15.6%) and from non-obesity to obesity (11.9% vs. 9.3%). Unfavorable lifestyle patterns were most pronounced among stroke survivors with severe post-stroke disability.Conclusion: A substantial proportion of stroke survivors did not adopt favorable lifestyle changes, particularly those with post-stroke disability. Comprehensive lifestyle risk factor modification requires multidisciplinary, individualized interventions tailored to disability status.