Abstract Background and aims Active transportation has been associated with favorable cardiovascular outcomes, but its long-term relationship with stroke incidence remains insufficiently understood. The aim was to assess the association between transportation mode and incident stroke in a large Swedish cohort, and to examine associations between commuting distance and incident stroke. Methods Population-based cohort study using data from 119,990 participants in the Västerbotten Intervention Program, collected between 1989 and 2019. Analyses included 107,752 participants (mean SD age, 45.7 8.8 years; 49.5% female) with complete data on transportation mode. Exposure variables: Primary mode of transportation to work and commuting distance were self-reported at baseline, defined as using the same main transport mode in at least three of four seasons. Main outcomes: Incident stroke diagnoses obtained from the Swedish Stroke Register. Associations were estimated using cause-specific Cox proportional hazards models. Results Over a median follow-up of 17 years, 3,507 (3.3%) participants developed stroke. Cycling to work was associated with a lower risk of incident stroke compared with driving (adjusted hazard ratio aHR, 0.89; 95% CI, 0.81–0.97; P = 0.020), but this association was attenuated after adjusting for leisure-time physical activity. Among car drivers, longer commuting distance was linearly associated with higher stroke risk (P = 0.040), whereas cyclists showed a nonlinear pattern with lower risk at moderate distances (P = 0.034). Conclusions Active commuting may help prevent stroke as part of an overall physically active lifestyle. Promoting active transportation could represent a sustainable strategy for reducing cardiovascular disease burden in the population. Conflict of interest Annie Palstam. Nothing to disclose. Frida Bergman. Nothing to disclose. Patrik Wennberg. Nothing to disclose. Katharina Stibrant Sunnerhagen. Nothing to disclose. Adam Viktorisson. Nothing to disclose.
Palstam et al. (2026) studied this question.