Mediterranean Diet Reduces Risk of Incident Stroke in a Population with Varying Cardiovascular Disease Risk Profiles

Katherine E. Paterson, Phyo K. Myint, Amy Jennings, Lucy K. M. Bain, Marleen A. H. Lentjes, Kay-Tee Khaw, Ailsa A. Welch (Corresponding Author)

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Abstract

Background and Purpose— Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk. Methods— We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5% women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score. Results— During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95% CI, 0.74–0.94; P-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95% CI, 0.65, 0.93; P-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95% CI, 0.79–1.12; P-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95% CI, 0.76–0.99; P-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95% CI, 0.65–0.97; P-trend =0.02). Conclusions— Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.
Original languageEnglish
Pages (from-to)2415-2420
Number of pages6
JournalStroke
Volume49
Issue number10
Early online date20 Sep 2018
DOIs
Publication statusPublished - 2018

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Mediterranean Diet
Cardiovascular Diseases
Stroke
Population
Cohort Studies

Keywords

  • diet
  • cardiovascular disease
  • stroke
  • women
  • epidemiology

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Paterson, K. E., Myint, P. K., Jennings, A., Bain, L. K. M., Lentjes, M. A. H., Khaw, K-T., & Welch, A. A. (2018). Mediterranean Diet Reduces Risk of Incident Stroke in a Population with Varying Cardiovascular Disease Risk Profiles. Stroke, 49(10), 2415-2420. https://doi.org/10.1161/STROKEAHA.117.020258

Mediterranean Diet Reduces Risk of Incident Stroke in a Population with Varying Cardiovascular Disease Risk Profiles. / Paterson, Katherine E. ; Myint, Phyo K.; Jennings, Amy; Bain, Lucy K. M.; Lentjes, Marleen A. H.; Khaw, Kay-Tee; Welch, Ailsa A. (Corresponding Author).

In: Stroke, Vol. 49, No. 10, 2018, p. 2415-2420.

Research output: Contribution to journalArticle

Paterson, KE, Myint, PK, Jennings, A, Bain, LKM, Lentjes, MAH, Khaw, K-T & Welch, AA 2018, 'Mediterranean Diet Reduces Risk of Incident Stroke in a Population with Varying Cardiovascular Disease Risk Profiles', Stroke, vol. 49, no. 10, pp. 2415-2420. https://doi.org/10.1161/STROKEAHA.117.020258
Paterson, Katherine E. ; Myint, Phyo K. ; Jennings, Amy ; Bain, Lucy K. M. ; Lentjes, Marleen A. H. ; Khaw, Kay-Tee ; Welch, Ailsa A. / Mediterranean Diet Reduces Risk of Incident Stroke in a Population with Varying Cardiovascular Disease Risk Profiles. In: Stroke. 2018 ; Vol. 49, No. 10. pp. 2415-2420.
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abstract = "Background and Purpose— Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk. Methods— We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5{\%} women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score. Results— During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95{\%} CI, 0.74–0.94; P-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95{\%} CI, 0.65, 0.93; P-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95{\%} CI, 0.79–1.12; P-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95{\%} CI, 0.76–0.99; P-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95{\%} CI, 0.65–0.97; P-trend =0.02). Conclusions— Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.",
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T1 - Mediterranean Diet Reduces Risk of Incident Stroke in a Population with Varying Cardiovascular Disease Risk Profiles

AU - Paterson, Katherine E.

AU - Myint, Phyo K.

AU - Jennings, Amy

AU - Bain, Lucy K. M.

AU - Lentjes, Marleen A. H.

AU - Khaw, Kay-Tee

AU - Welch, Ailsa A.

N1 - The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.117.020258. EPIC-Norfolk is supported by the Medical Research Council program grants (G0401527 and G1000143) and Cancer Research UK program grants (C864/A8257 and C864/A14136).

PY - 2018

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N2 - Background and Purpose— Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk. Methods— We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5% women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score. Results— During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95% CI, 0.74–0.94; P-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95% CI, 0.65, 0.93; P-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95% CI, 0.79–1.12; P-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95% CI, 0.76–0.99; P-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95% CI, 0.65–0.97; P-trend =0.02). Conclusions— Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.

AB - Background and Purpose— Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk. Methods— We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5% women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score. Results— During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95% CI, 0.74–0.94; P-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95% CI, 0.65, 0.93; P-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95% CI, 0.79–1.12; P-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95% CI, 0.76–0.99; P-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95% CI, 0.65–0.97; P-trend =0.02). Conclusions— Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.

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KW - cardiovascular disease

KW - stroke

KW - women

KW - epidemiology

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JO - Stroke

JF - Stroke

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