Stroke Alert: A Review of Current Clinical Stroke Literature

By Matthew E. Fink, MD, Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital.

This article originally appeared in the April 2013 issue of Neurology Alert. It was peer reviewed by M. Flint Beal, MD. Dr. Beal is Anne Parrish Titzel Professor, Department of Neurology and Neuroscience, Weill Cornell Medical Center. Dr. Fink is a retained consultant for MAQUET and Dr. Beal reports no financial relationships relevant to this field of study.

Synopsis: Mediterranean diet can reduce risk for stroke

Source: Estruch R, et al, for the PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; Feb. 25. DOI: 10.1056/NEJMoa1200303. [Epub ahead of print].

The PREDIMED investigators from Barcelona, Spain, reported the results of their multicenter, randomized dietary treatment trial of the effects of three different diets on cardiovascular events — a Mediterranean diet supplemented with extra virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet that included advice to reduce dietary fat. The Mediterranean diet is characterized by a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation consumed with meals. A number of observational cohort studies suggested that this diet, over many years, might confer a reduced risk of cardiovascular disease, but this was the first large-scale, randomized study that directly compared diets. The primary endpoint was the rate of major cardiovascular diseases (myocardial infarction, stroke, death from cardiovascular causes), and the trial was stopped early (median follow-up of 4.8 years) when an interim analysis showed a significant difference in outcomes, based on which diet was instituted.

The enrolled subjects were free of cardiovascular disease, but had risk factors for disease — type 2 diabetes mellitus, or at least three of the following other risk factors: smoking, hypertension, elevated LDL, low HDL, obesity, or family history of premature coronary heart disease. A total of 7447 patients were enrolled (ages 55 to 80 years); 57% were women, and they were followed for a mean time of 4.8 years before the study was terminated. In a multivariable-adjusted analysis, the hazard ratios were 0.70 (95% confidence interval [CI], 0.54-0.92) for the Mediterranean diet with extra virgin olive oil, and 0.72 (95% CI, 0.54-0.96) for the group assigned to the Mediterranean diet with nuts, vs the control group. For stroke alone, the hazard ratios for the two Mediterranean diets were 0.67 (olive oil) and 0.54 (nuts). Adherence to the Mediterranean diet results in a clinically and statistically significant reduction in cardiovascular events, especially stroke.