Does Eating a Mediterranean Diet Reduce Risk of Stroke in Both Men and Women?
BACKGROUND AND PURPOSE:
Paterson et al. (Stroke, 2018) assessed whether the beneficial effect of Mediterranean diet (MD) on stroke risk is maintained across cardiovascular disease risk or sex
Observational prospective population-based cohort study
Adherence to the MD score was investigated based on 7-day dietary diaries
Fruit and nuts | Vegetables | Legumes | Cereals (including bread and potatoes) | Fish | Higher unsaturated fat:saturated fat ratio
Outcome: Does incident stroke risk differ based on
Male vs female
CVD risk category
Individual nutritional components of the MD
23,232 men and women were included in the study
54% were women
UK white population
Mean age: 59/1 years
2009 incident strokes occurred during the 17 years of follow-up
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 women, MD reduced stroke risk (quartile 4 versus quartile 1)
HR 0.78 (95% CI, 0.65, 0.93; P-trend <0.01)
Menopausal status and hormone therapy did not affect results
MD did not significantly reduce stroke risk for 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 higher risk of cardiovascular disease and CVD risk categories (quartile 4 versus quartile 1)
HR 0.87 (95% CI, 0.76–0.99; P-trend =0.04)
This finding 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)
There were few significant associations with individual MD components
Following a Mediterranean diet is associated with a decreased risk for stroke across cardiovascular risk level and was driven to significance by women
The authors state
It is important to understand sex differences in exposure to the MD because women have unique stroke RFs, which include postmenopausal hormone use, hormone status changes, pregnancy, preeclampsia, gestational diabetes mellitus, and oral contraceptive use. The prevalence of other RFs differs between men and women with hypertension, diabetes mellitus, atrial fibrillation, and migraine with aura being more prevalent in women.
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