Obesity, Smoking, Physical Activity, Hypertension: Models of Stroke Causes in South Sulawesi Province


Lifestyle changes have led to an increase in cases of non-communicable diseases in Indonesia, including hypertension and stroke. Unhealthy eating behavior, smoking habits, alcohol consumption, stress, and lack of physical activity are risk factors for degenerative diseases, besides the other risk factors such as age, gender, and heredity. This research aimed to determine the factor of obesity, smoking behavior, physical activity, and hypertension on the incidence of stroke in South Sulawesi Province. The method of research was analytic observational with a case-control approach. The case group was stroke patients as many as 750 cases and the control group was non-stroke patients as many as 750 cases. Data analysis using Path analysis. The results showed that there was a significant relationship between stroke and hypertension with a path coefficient value of 0.33, the relationship between physical activity and the incidence of stroke through hypertension with a path coefficient value of 0.13, obesity and the incidence of stroke through hypertension with a path coefficient value of 0, 21, there is a relationship between smoking and the incidence of stroke through hypertension with a path coefficient value of 0.08. Hypertension is a risk factor that directly affects the incidence of stroke compared to other risk factors. however, all of these risk factors can be reduced, especially by doing routine and regular physical activity every day.


Aaby, A., Friis, K., Christensen, B., Rowlands, G., & Maindal, H. T. (2017). Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease. European journal of preventive cardiology, 24(17), 1880-1888. https://doi.org/10.1177/2047487317729538

Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Das, S. R. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528. https://doi.org/10.1161/CIR.0000000000000659

Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Deo, R. (2018). Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation, 137(12), e67-e492. https://doi.org/10.1161/CIR.0000000000000558

Boan, A. D., Egan, B. M., Bachman, D. L., Adams, R. J., Feng, W., Jauch, E. C., Lackland, D. T. (2014). Antihypertensive Medication Persistence 1‐Year Post‐Stroke Hospitalization. The Journal of Clinical Hypertension, 16(12), 869-874. https://doi.org/10.1111/jch.12424

Bousser, M. G. (2012). Stroke prevention: an update. Front Med, 6(1), 22-34. https://doi.org/10.1007/s11684-012-0178-6

Bushnell, C., Arnan, M., & Han, S. (2014). A new model for secondary prevention of stroke: transition coaching for stroke. Frontiers in neurology, 5, 219. https://doi.org/10.3389/fneur.2014.00219

Castelli, W. (1988). Cholesterol and lipids in the risk of coronary artery disease--the Framingham Heart Study. The Canadian journal of cardiology, 4, 5A-10A. https://europepmc.org/article/med/3179802

Chang, S., Kim, H., Kim, V., Lee, K., Jeong, H., Lee, J.-H., Ko, E. (2016). Association Between Smoking and Physician-Diagnosed Stroke and Myocardial Infarction in Male Adults in Korea. Int J Environ Res Public Health, 13(2), 158. https://doi.org/10.3390/ijerph13020158

Chang, W. H., Shin, Y.-I., Lee, S.-G., Oh, G.-J., Lim, Y. S., & Kim, Y.-H. (2015). Characteristics of inpatient care and rehabilitation for acute first-ever stroke patients. Yonsei medical journal, 56(1), 262-270. https://doi.org/10.3349/ymj.2015.56.1.262

Feigin, V. L., & Krishnamurthi, R. (2011). Stroke prevention in the developing world. Stroke, 42(12), 3655-3658. http://doi.org/10.1161/strokeaha.110.596858

Gaciong, Z., Siński, M., & Lewandowski, J. (2013). Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses. Current hypertension reports, 15(6), 559-574. https://doi.org/10.1007/s11906-013-0401-0

Helms, T. M., Duong, G., Zippel-Schultz, B., Tilz, R. R., Kuck, K.-H., & Karle, C. A. (2014). Prediction and personalised treatment of atrial fibrillation—stroke prevention: consolidated position paper of CVD professionals. EPMA Journal, 5(1), 1-7. https://doi.org/10.1186/1878-5085-5-15

Jain, R. B., & Ducatman, A. (2018). Associations between smoking and lipid/lipoprotein concentrations among US adults aged≥ 20 years. Journal of circulating biomarkers, 7, 1849454418779310. https://doi.org/10.1186/s12889-020-08809-z

Kammerlind, A.-S. C., Bravell, M. E., & Fransson, E. I. (2016). Prevalence of and factors related to mild and substantial dizziness in community-dwelling older adults: a cross-sectional study. BMC Geriatr, 16(1), 159. https://doi.org/10.1186/s12877-016-0335-x

Kernan, W. N., Inzucchi, S. E., Sawan, C., Macko, R. F., & Furie, K. L. (2013). Obesity: a stubbornly obvious target for stroke prevention. Stroke, 44(1), 278-286. https://doi.org/10.1161/STROKEAHA.111.639922

Kernan, W. N., Inzucchi, S. E., Sawan, C., Macko, R. F., & Furie, K. L. (2013). Obesity: a stubbornly obvious target for stroke prevention. Stroke, 44(1), 278-286. http://doi.org/10.1161/strokeaha.111.639922

Khodamoradi, F., Nazemipour, M., Mansournia, N., Yazdani, K., Khalili, D., & Mansournia, M. A. (2021). The effects of smoking on metabolic syndrome and its components using causal methods in the Iranian population. International Journal of Preventive Medicine, 12. https://dx.doi.org/10.4103%2Fijpvm.ijpvm_45_21

Liao, L.-R., Ng, G. Y., Jones, A. Y., Chung, R. C., & Pang, M. Y. (2015). Effects of vibration intensity, exercise, and motor impairment on leg muscle activity induced by whole-body vibration in people with stroke. Physical therapy, 95(12), 1617. https://doi.org/10.2522/ptj.20140507

Lin, A. W., Kazemi, M., Jarrett, B. Y., Vanden Brink, H., Hoeger, K. M., Spandorfer, S. D., & Lujan, M. E. (2019). Dietary and physical activity behaviors in women with polycystic ovary syndrome per the new international evidence-based guideline. Nutrients, 11(11), 2711. https://doi.org/10.3390/nu11112711

Ma, H. T. (2014). A blood pressure monitoring method for stroke management. BioMed research international, 2014. https://doi.org/10.1155/2014/571623

Miller, V., Mente, A., Dehghan, M., Rangarajan, S., Zhang, X., Swaminathan, S., Lear, S. (2017). Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. The Lancet, 390(10107), 2037-2049. https://doi.org/10.1016/S0140-6736(17)32253-5

Muraki, I., Wu, H., Imamura, F., Laden, F., Rimm, E. B., Hu, F. B., Q. (2015). Rice consumption and risk of cardiovascular disease: results from a pooled analysis of 3 US cohorts. The American journal of clinical nutrition, 101(1), 164-172. https://doi.org/10.3945/ajcn.114.087551

Nyberg, S. T., Batty, G. D., Pentti, J., Virtanen, M., Alfredsson, L., Fransson, E. I., Knutsson, A. (2018). Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study. The lancet Public health, 3(10), e490-e497. https://doi.org/10.1016/S2468-2667(18)30139-7

O’Keeffe, L. M., Taylor, G., Huxley, R. R., Mitchell, P., Woodward, M., & Peters, S. A. (2018). Smoking as a risk factor for lung cancer in women and men: a systematic review and meta-analysis. BMJ open, 8(10), e021611. http://dx.doi.org/10.1136/bmjopen-2018-021611

O'collins, V. E., Donnan, G. A., Macleod, M. R., & Howells, D. W. (2013). Hypertension and experimental stroke therapies. Journal of Cerebral Blood Flow & Metabolism, 33(8), 1141-1147. https://doi.org/10.1038%2Fjcbfm.2013.88

Prabhakar, C. R. K., & Stewart, R. (2018). Physical activity and mortality in patients with stable coronary heart disease. Current opinion in cardiology, 33(6), 653-659. http://doi.org/10.1097/HCO.0000000000000563

Kementerian Kesehatan RI. (2013). Penyajian Pokok-Pokok Hasil Riset Kesehatan Dasar 2013.

Sjøgren, P., Ekholm, O., Peuckmann, V., & Grønbæk, M. (2009). Epidemiology of chronic pain in Denmark: an update. European Journal of Pain, 13(3), 287-292. https://doi.org/10.1016/j.ejpain.2008.04.007

Stewart, R. A., Held, C., Hadziosmanovic, N., Armstrong, P. W., Cannon, C. P., Granger, C. B., Lonn, E. (2017). Physical activity and mortality in patients with stable coronary heart disease. Journal of the American College of Cardiology, 70(14), 1689-1700. https://doi.org/10.1016/j.jacc.2017.08.017

Tang, R., Yang, S., Liu, W., Yang, B., Wang, S., Yang, Z., & He, Y. (2020). Smoking is a risk factor of coronary heart disease through HDL-C in Chinese T2DM patients: a mediation analysis. Journal of Healthcare Engineering, 2020. https://doi.org/10.1155/2020/8876812

Tewatia, P., Kaushik, R. M., Kaushik, R., & Kumar, S. (2020). Tobacco smoking as a risk factor for tuberculous pleural effusion: a case-control study. Global health, epidemiology and genomics, 5. https://doi.org/10.1017/gheg.2020.1

Trigueros, R., Mínguez, L. A., González-Bernal, J. J., Jahouh, M., Soto-Camara, R., & Aguilar-Parra, J. M. (2019). Influence of teaching style on physical education adolescents’ motivation and health-related lifestyle. Nutrients, 11(11), 2594. https://doi.org/10.3390/nu11112594

Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Delling, F. N. (2021). Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation, 143(8), e254-e743. https://doi.org/10.1161/CIR.0000000000000950

Wisløff, T., Hagen, G., & Klemp, M. (2014). Economic evaluation of warfarin, dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation. Pharmacoeconomics, 32(6), 601-612. https://doi.org/10.1007/s40273-014-0152-z

Zehr, E. P. (2011). Evidence-based risk assessment and recommendations for physical activity clearance: stroke and spinal cord injury. Appl Physiol Nutr Metab, 36 Suppl 1, S214-231. https://doi.org/10.1139/h11-055

Zhang, L., & Yang, L. (2014). Anti-inflammatory effects of vinpocetine in atherosclerosis and ischemic stroke: a review of the literature. Molecules, 20(1), 335-347. https://doi.org/10.3390/molecules20010335

How to Cite
Awal, M., Ashriady, A., Durahim, D., & Adam, A. (2021). Obesity, Smoking, Physical Activity, Hypertension: Models of Stroke Causes in South Sulawesi Province. Al-Sihah: The Public Health Science Journal, 13(2), 198-206. https://doi.org/10.24252/al-sihah.v13i2.22172
Volume 13, Nomor 2, Tahun 2021
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