American College of Cardiology

American College of Cardiology

March 20, 2020
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Dietary choices impact stroke risk

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Ischemic stroke risk was inversely associated with the consumption of dietary fiber, fruit and vegetables, and dairy foods such as milk and cheese, according to a study published in the European Heart Journal.

The study also found that higher egg consumption increased the risk for hemorrhagic stroke.

“The most important finding is that higher consumption of both dietary fiber and fruit and vegetables was strongly associated with lower risks of ischemic stroke, which supports current European guidelines,” Tammy Y.N. Tong, BSc, MPhil, PhD, nutritional epidemiologist in the Nuffield Department of Public Health at the University of Oxford, U.K., said in a press release. “The general public should be recommended to increase their fiber and fruit and vegetable consumption if they are not already meeting these guidelines.”

Researchers analyzed data from 418,329 patients who were recruited for the European Prospective Investigation into Cancer and Nutrition (EPIC) study from 22 centers in nine European countries between 1992 and 2000. Patients in this study completed lifestyle and dietary questionnaires at recruitment to collect information on habitual diets, sociodemographic characteristics, medical history and lifestyle factors.

The intake of several food groups and subgroups were estimated: fish and fish products, meat and meat products, eggs, dairy products, fruits and vegetables, cereals and cereal products, nuts and seeds, legumes and dietary fiber.

The primary endpoints were hemorrhagic and ischemic stroke, with total stroke as a secondary outcome of interest.

During a mean follow-up of 12.7 years, there were 4,281 cases of ischemic stroke, 1,430 cases of hemorrhagic stroke and 7,378 cases of total stroke, which included hemorrhagic, ischemic and unspecified stroke.

Lower risk for ischemic stroke was observed in patients with high consumption of dietary fiber (HR per 10 g per day = 0.77; 95% CI, 0.69-0.86; P for trend < .001), fruits and vegetables combined (HR per 200 g per day higher intake = 0.87; 95% CI, 0.82-0.93; P for trend < .001), cheese (HR per 30 g per day = 0.88; 95% CI, 0.81-0.97; P for trend = .008), yogurt (HR per 100 g per day = 0.91; 95% CI, 0.85-0.97; P for trend = .004) and milk (HR per 200 g per day = 0.95; 95% CI, 0.91-0.99; P for trend = .02). Higher red meat consumption was associated with an increased risk for ischemic stroke (HR per 50 g per day = 1.14; 95% CI, 1.02-1.27; P for trend = .02), which was attenuated after adjusting for other significant foods (HR = 1.07; 95% CI, 0.96-1.2; P for trend = .2).

Higher egg consumption increased the risk for hemorrhagic stroke (HR per 20 g per day = 1.25; 95% CI, 1.09-1.43; P for trend = .002). Other significant associations were not observed for hemorrhagic stroke.

“The observed associations might be partly explained by effects on blood pressure and blood cholesterol,” Tong and colleagues wrote. “The different dietary factors associated with risk of ischemic and hemorrhagic stroke highlight the importance of differentiating stroke subtypes in epidemiological studies.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.