In addition, increased very low-density lipoprotein production caused by the high lipolytic activity of abdominal adipose tissue304,312 may increase stroke risk. Lifestyle Lifestyle factors such as a healthy diet,336 338 physical activ- abstinence from smoking,344 346 moderate alcohol and maintenance of a healthy BMI299,308 reduce the risk of CVD and mortality. Adherence to a combination of healthy lifestyle practices has been shown to decrease stroke incidence in women327 and improve outcomes after stroke in both men and women.349 All-cause mortality after stroke decreases with higher numbers of healthy behaviors (1 3 factors versus none: HR, 0.12 [95% CI, 0.03 0.47]; 4 5 factors versus none: are observed for cardiovascular mortality after stroke (4 5 fac- tors versus none: HR, 0.08 [95% CI, 0.01 0.66]; 1 3 factors ver- A multitude of randomized controlled trials of lifestyle inter- ventions targeting individuals at high risk for diabetes mel- litus and CVD have been conducted.350 362 Although many of the studies have proved effective in improving lifestyle habits and vascular risk factors in the short term, it has proved more challenging to maintain such changes and reduce cardiovascu- lar events. For example, in the WHI Randomized Controlled Dietary Modification Trial, over a mean of 8.1 years, the dietary intervention reduced total fat intake and increased intakes of vegetables, fruits, and grains but did not significantly reduce the risk of coronary heart disease, stroke, or cardiovascular death in postmenopausal women and achieved only modest effects on cardiovascular risk factors.358 In addition, a 2-year behavior- ally based physical activity and diet program implemented to reduce obesity in a primary care setting showed a significant reduction in waist circumference at 6 and 12 months, but the reduction in waist circumference was sustained in men but not On the other hand, a recent primary Table 10. 