Adherence to Different Dietary Patterns and Subsequent Risk of Total, Ischemic, and Hemorrhagic Stroke

Abstract

BACKGROUND: Adherence to healthy dietary patterns has been related to lower cardiovascular disease risk. However, few studies have examined prospective associations between adherence to different healthy dietary scores and the incidence of stroke and its subtypes. The aim of this study was to prospectively examine the associations between adherence to 4 recognized healthy dietary patterns and the risk of total and ischemic stroke in an existing dietary-based randomized controlled trial. METHODS: This is a secondary observational cohort analysis of 7447 participants at high cardiovascular disease risk enrolled in the PREDIMED trial (Prevención Con Dieta Mediterranea). Dietary scores for 4 healthy dietary patterns, including the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diets, and the Planetary Health Diet Index, were derived from repeated food frequency questionnaires. Participants were classified into quintiles of cumulative average adherence of the 4 dietary scores. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the healthy dietary scores and risk of stroke and stroke subtypes. RESULTS: During a total of 31 024 person-years of follow-up (median, 4.3 years), 135 stroke cases were documented (112 ischemic and 23 hemorrhagic strokes). Comparing the highest versus the lowest quintile of dietary scores, the multivariable-adjusted hazard ratio of total stroke was 0.26 (95% CI, 0.14-0.51) for Mediterranean diet and 0.25 (95% CI, 0.13-0.51) for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diet, while no significant associations were observed for the DASH diet (adjusted hazard ratio, 0.76 [95% CI, 0.42-1.39]) or the Planetary Health Diet Index (adjusted hazard ratio, 0.57 [95% CI, 0.30-1.08]). Similar associations were observed for ischemic stroke. CONCLUSIONS: In individuals at high cardiovascular disease risk, greater adherence to the Mediterranean and Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diets was associated with a lower risk of total stroke and ischemic stroke. REGISTRATION: URL: https://www.isrctn.com/; Unique identifier: ISRCTN35739639.