Adherence to a Mediterranean diet and prediction of incident stroke

doi:10.1161/STROKEAHA.114.007894

. 2015 Mar;46(3):780-5.

doi: 10.1161/STROKEAHA.114.007894. Epub 2015 Jan 27.

Adherence to a Mediterranean diet and prediction of incident stroke

Affiliations

¹ From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.). tsivgoulisgiorg@yahoo.gr.
² From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).

PMID: 25628306
PMCID: PMC4621211
DOI: 10.1161/STROKEAHA.114.007894

Adherence to a Mediterranean diet and prediction of incident stroke

Georgios Tsivgoulis et al. Stroke. 2015 Mar.

. 2015 Mar;46(3):780-5.

doi: 10.1161/STROKEAHA.114.007894. Epub 2015 Jan 27.

Affiliations

¹ From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.). tsivgoulisgiorg@yahoo.gr.
² From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).

PMID: 25628306
PMCID: PMC4621211
DOI: 10.1161/STROKEAHA.114.007894

Abstract

Background and purpose: There are limited data on the potential association of adherence to Mediterranean diet (MeD) with incident stroke. We sought to assess the longitudinal association between greater adherence to MeD and risk of incident stroke.

Methods: We prospectively evaluated a population-based cohort of 30 239 individuals enrolled in REasons for Geographic and Racial Differences in Stroke (REGARDS) study, after excluding participants with stroke history, missing demographic data or food frequency questionnaires, and unavailable follow-up information. Adherence to MeD was categorized using MeD score. Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years.

Results: Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke [IS] and hemorrhagic stroke, respectively) of 20 197 individuals fulfilling the inclusion criteria. High adherence to MeD (MeD score, 5-9) was associated with lower risk of incident IS in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70-1.00; P=0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65-0.96; P=0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When MeD was evaluated as a continuous variable, a 1-point increase in MeD score was independently associated with a 5% reduction in the risk of incident IS (95% confidence interval, 0-11%). We documented no association of adherence to MeD with incident hemorrhagic stroke. There was no interaction of race (P=0.37) on the association of adherence to MeD with incident IS.

Conclusions: High adherence to MeD seems to be associated with a lower risk of incident IS independent of potential confounders. Adherence to MeD is not related to the risk of incident hemorrhagic stroke.

Keywords: diet, Mediterranean; hemorrhagic disorders; patient adherence; stroke; transient ischemic attack.

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There are no conflicts of interest to disclose.

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References

1. Roger VL, Go AS, Lloyd-Jones DM, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220. - PMC - PubMed
1. Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2008. Natl Vital Stat Rep. 2011;59:1–126. - PubMed
1. Hall MJ, Levant S, DeFrances CJ. Hospitalization for stroke in U.S hospitals, 1989–2009. NCHS Data Brief. 2012;95:1–8. - PubMed
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1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–1360. - PubMed

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[1] Roger VL, Go AS, Lloyd-Jones DM, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220. - PMC - PubMed

[2] Roger VL, Go AS, Lloyd-Jones DM, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220. - PMC - PubMed

[3] Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2008. Natl Vital Stat Rep. 2011;59:1–126. - PubMed

[4] Miniño AM, Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2008. Natl Vital Stat Rep. 2011;59:1–126. - PubMed

[5] Hall MJ, Levant S, DeFrances CJ. Hospitalization for stroke in U.S hospitals, 1989–2009. NCHS Data Brief. 2012;95:1–8. - PubMed

[6] Hall MJ, Levant S, DeFrances CJ. Hospitalization for stroke in U.S hospitals, 1989–2009. NCHS Data Brief. 2012;95:1–8. - PubMed

[7] Howard G, Goff DC. Population shifts and the future of stroke: Forecasts of the future burden of stroke. Annals of the New York Academy of Sciences. 2012;1268:14–205. - PMC - PubMed

[8] Howard G, Goff DC. Population shifts and the future of stroke: Forecasts of the future burden of stroke. Annals of the New York Academy of Sciences. 2012;1268:14–205. - PMC - PubMed

[9] Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–1360. - PubMed

[10] Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–1360. - PubMed

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Adherence to a Mediterranean diet and prediction of incident stroke

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Adherence to a Mediterranean diet and prediction of incident stroke

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