Home > Food and Drink, Heart Health, Nutrition > Stroke Protection Diet

Stroke Protection Diet

October 13, 2012 Written by JP    [Font too small?]

Staying informed about the latest health care news is clearly beneficial. Knowledge is indeed power. However, information is only as valuable as your ability and/or willingness to apply it. Presently, an example is found in the field of stroke research. Several current studies point to nutritional interventions which may reduce the risk of stroke. Implementing these delicious and simple dietary approaches could significantly reduce the burden that strokes inflict on individuals, families and the health care system. The key is to find practical ways of accomplish this objective.

Strokes are sometimes referred to as “brain attacks”. They occur when blood flow is temporarily interrupted to the brain. When this absence of circulation persists for more than a few seconds, tissue damage occurs due to a lack of oxygen. Strokes are typically classified into two categories: 1) hemorrhagic stroke; 2) ischemic stroke. The ischemic variety is caused by excessive clotting that prevents blood supply from reaching the brain. On the other hand, hemorrhagic strokes are precipitated by the leak or rupture of a weakened blood vessel in the brain.

An excellent and flavorful approach to lowering stroke incidence is to adopt a low carbohydrate, Mediterranean style diet. Regular adherence to a typical Mediterranean menu plan is estimated to confer 12% protection against stroke. That said, the frequent inclusion of select foods common to the Mediterranean region such as apples, dark chocolate, fish, low-fat dairy, nuts, olive oil and red wine may provide even greater protection against both hemorrhagic and ischemic strokes.

Here’s an example of a meal that incorporates several of the foods that modern science has associated with stroke prevention:

  • Appetizer: Heirloom Tomato Slices topped w/ Fresh Burrata Cheese and Extra Virgin Olive Oil
  • Main Course: A Fillet of Wild Salmon w/ Sauteed Broccoli or Spinach and a Glass of Red Wine
  • Dessert: A Baked Apple sprinkled w/ Chopped Nuts & Cinnamon or a piece of Dark Chocolate

Every single item on the above menu has been found to lower one or more risk factors for stroke. For instance, apple polyphenols were recently shown to stunt cholesterol oxidation, thereby keeping arteries supple. Pure cocoa supports healthier blood flow to the brain and discourages systemic inflammation, which may contribute to cardiovascular complications. And, new research contained in the journal Neurology indicates that regular tomato consumption is linked to a 59% decreased rate of “any stroke” in middle-aged men. Now, that’s powerful “medicine”! The implications of this current batch of studies is that food can, in fact, be used strategically to lower the likelihood of stroke. The question now is whether or not this research will be put to use and widely disseminated.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Click on the following links to learn more about the studies referenced in today’s column:

Study 1 – Mediterranean Style Diet and 12-Year Incidence of Cardiovascular (link)

Study 2 – Comparison of Eicosapentaenoic Acid Concentrations in Plasma(link)

Study 3 – Serum Lycopene Decreases the Risk of Stroke in Men (link)

Study 4 – Dairy Consumption and Risk of Stroke in Swedish Women and Men (link)

Study 5 – Olive Oil Consumption, Plasma Oleic Acid, and Stroke Incidence(link)

Study 6 – Alcohol Consumption and Risk of Recurrent Cardiovascular Events (link)

Study 7 – Intakes of Apples or Apple Polyphenols Decrease Plasma Values (link)

Study 8 – Dietary Protein Sources and the Risk of Stroke in Men and Women (link)

Study 9 – Effects of Cinnamon Consumption on Glycemic Status, Lipid Profile (link)

Study 10 – Cocoa, Blood Pressure, and Vascular Function (link)

Cruciferous & Green Leafy Vegetable Intake Reduce Stroke Risk

Source: JAMA. 1999;282(13):1233-1239. (link)

Tags: , ,
Posted in Food and Drink, Heart Health, Nutrition

16 Comments & Updates to “Stroke Protection Diet”

  1. Charlie Says:

    Stroke definitions are reversed.

  2. Alicia Says:

    It makes sense that a Mediterranean diet can help decrease incidence of stroke because of its many heart healthy effects. According to Natural Standard, the Mediterranean diet has shown a low incidence of chronic diseases including heart disease, high blood pressure, and high cholesterol, and may reduce heart attacks and Alzheimer’s disease. It has also been seen that people who consume a Mediterranean diet often live longer than those who do not. The Mediterranean diet also seems like an easier to follow diet than many out there, because so many delicious foods are still consumed, and are guilt free, including chocolate, olive oil, nuts, and wine. It is easy to incorporate these eating habits into every day life, just by using olive oil to cook instead of vegetable oil, natural peanut butter on toast instead of butter, and a glass of red wine with dinner! Thanks for the healthy menu options, and for spreading the word on such a delicious and healthy diet.

  3. JP Says:

    Thank you, Alicia. 🙂

    I agree that the research on the Mediterranean Diet is quite strong. What’s more, the greater the adherence to the diet, the better the results. Also, making good choices, within the context of a Mediterranean-style diet, such as opting for lower glycemic foods and ingredients, tops my list of suggestions for improved cardiovascular health.



    Be well!


  4. JP Says:

    Update: Make sure to eat plenty of potassium-rich foods!


    “The researchers found:

    Women who ate the most potassium were 12 percent less likely to suffer stroke in general and 16 percent less likely to suffer an ischemic stroke than women who ate the least.

    Women who ate the most potassium were 10 percent less likely to die than those who ate the least.

    Among women who did not have hypertension (whose blood pressure was normal and they were not on any medications for high blood pressure), those who ate the most potassium had a 27 percent lower ischemic stroke risk and 21 percent reduced risk for all stroke types, compared to women who ate the least potassium in their daily diets.

    Among women with hypertension (whose blood pressure was high or they were taking drugs for high blood pressure), those who ate the most potassium had a lower risk of death, but potassium intake did not lower their stroke risk.”

    Be well!


  5. JP Says:

    pdate: Flax oil may protect the brain from stroke damage and possibly promote recovery …


    Nutrition Journal 2015, 14:20

    Oral consumption of α-linolenic acid increases serum BDNF levels in healthy adult humans

    Background aims Dietary omega-6 and omega-3 fatty acids have remarkable impacts on the levels of DHA in the brain and retina. Low levels of DHA in plasma and blood hamper visual and neural development in children and cause dementia and cognitive decline in adults. The level of brain-derived neurotrophic factors (BDNF) changes with dietary omega-3 fatty acid intake. BDNF is known for its effects on promoting neurogenesis and neuronal survival. Methods In this study, we examined the effect of the oral consumption of α-Linolenic acid (ALA) on blood levels of BDNF and Malondialdehyde (MDA) in healthy adult humans. 30 healthy volunteers, 15 men and 15 women, were selected randomly. Each individual served as his or her own control. Before consuming the Flaxseed oil capsules, 5cc blood from each individual was sampled in order to measure the plasma levels of BDNF and MDA as baseline controls. During the experiment, each individual was given 3 oral capsules of flaxseed oil, containing 500mg of alpha linolenic acid, daily for one week. Then, plasma levels of BDNF and MDA were tested. Results The plasma levels of BDNF and MDA significantly (P < 0.05) increased in individuals who received the oral capsules of ALA. Plasma levels of BDNF increased more in the women in comparison with the men. Conclusion ALA treatment could be a feasible approach to reduce size of infarcts in stroke patients. Thus, ALA could be used in adjunction with routine stroke therapies to minimize brain lesions caused by stroke.

    Be well!


  6. JP Says:

    Update: Relaxation training CD reduces post-stroke anxiety …


    Clin Rehabil March 16, 2015

    Objective: To consider relaxation as a potential treatment for anxiety in stroke survivors living in the community, including feasibility and acceptability.

    Design: Randomised two group design (intervention and control).

    Participants: All participants (n = 21) were stroke survivors living in the community who reported experiencing anxiety (Hospital Anxiety and Depression Scale – Anxiety Subscale ⩾ 6).

    Interventions: The intervention group were asked to listen to a self-help autogenic relaxation CD, five times a week, for at least one month. Participants completed the Hospital Anxiety and Depression Scale at screening and then monthly for three months.

    Results: At each assessment following screening, participants who received the relaxation training were significantly more likely to report reduced anxiety compared to those who had not received the training (Month 1 P = 0.002; Month 2 P < 0.001; Month 3 P = 0.001). After one month, seven of the intervention group (n = 10) had completed the relaxation training as directed and planned to continue using it. The intervention appeared practical to deliver and relatively inexpensive, with minimal adverse effects. Conclusions: Preliminary evidence suggests that autogenic relaxation training delivered in a self-help CD format is a feasible and acceptable intervention, and that anxiety is reduced in stroke survivors who received the intervention. Future studies should seek to recruit a larger and more heterogeneous sample of 70 participants. Be well! JP

  7. JP Says:



    Stroke. 2015 Mar 31.

    Multivitamin Use and Risk of Stroke Mortality: The Japan Collaborative Cohort Study.

    BACKGROUND AND PURPOSE: An effect of multivitamin supplement on stroke risk is uncertain. We aimed to examine the association between multivitamin use and risk of death from stroke and its subtypes.

    METHODS: A total of 72 180 Japanese men and women free from cardiovascular diseases and cancers at baseline in 1988 to 1990 were followed up until December 31, 2009. Lifestyles including multivitamin use were collected using self-administered questionnaires. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of total stroke and its subtypes in relation to multivitamin use.

    RESULTS: During a median follow-up of 19.1 years, we identified 2087 deaths from stroke, including 1148 ischemic strokes and 877 hemorrhagic strokes. After adjustment for potential confounders, multivitamin use was associated with lower but borderline significant risk of death from total stroke (HR, 0.87; 95% confidence interval, 0.76-1.01), primarily ischemic stroke (HR, 0.80; 95% confidence interval, 0.63-1.01), but not hemorrhagic stroke (HR, 0.96; 95% confidence interval, 0.78-1.18). In a subgroup analysis, there was a significant association between multivitamin use and lower risk of mortality from total stroke among people with fruit and vegetable intake <3 times/d (HR, 0.80; 95% confidence interval, 0.65-0.98). That association seemed to be more evident among regular users than casual users. Similar results were found for ischemic stroke.

    CONCLUSIONS: Multivitamin use, particularly frequent use, was associated with reduced risk of total and ischemic stroke mortality among Japanese people with lower intake of fruits and vegetables.

    Be well!


  8. JP Says:

    Update 05/18/15:


    Nutrition Research – May 13, 2015

    Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations

    Recent research suggests that traditional grain-based heart healthy diet recommendations, which replace dietary saturated fat with carbohydrate and reduce total fat intake, may result in unfavorable plasma lipid ratios, with reduced high-density lipoprotein (HDL) and an elevation of low-density lipoprotein (LDL) and triacylglycerols (TG). The current study tested the hypothesis that a grain-free Paleolithic diet would induce weight loss and improve plasma total cholesterol (TC), HDL, LDL and TG concentrations in non-diabetic adults with hyperlipidemia to a greater extent than a grain-based heart healthy diet, based on the recommendations of the American Heart Association. Twenty volunteers (10 male, 10 female) aged 40 to 62 years were selected based on diagnosis of hypercholesterolemia. Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart healthy diet for four months, followed by a Paleolithic diet for four months. Regression analysis was used to determine whether change in body weight contributed to observed changes in plasma lipid concentrations. Differences in dietary intakes and plasma lipid measures were assessed using repeated measures ANOVA. Four months of Paleolithic nutrition significantly lowered (P < 0.001) mean TC, LDL, and TG and increased (P < 0.001) HDL, independent of changes in body weight, relative to both baseline and the traditional heart healthy diet. Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart healthy dietary recommendations. Be well! JP

  9. JP Says:

    Updated 09/19/15:


    Atherosclerosis. 2015 Sep 3;243(1):93-98.

    A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study.

    BACKGROUND AND AIMS: The Mediterranean diet, which is palatable and easily achievable, has been associated with lower all-cause and cardiovascular disease (CVD) incidence and mortality. Data on heart failure (HF) and stroke types are lacking. The aim was to examine a Mediterranean diet in relation to incidence of myocardial infarction (MI), HF and stroke types in a Swedish prospective cohort.

    METHODS: In a population-based cohort of 32,921 women, diet was assessed through a self-administered questionnaire. The modified Mediterranean diet (mMED) score was created based on high consumption of vegetables, fruits, legumes, nuts, whole grains, fermented dairy products, fish and monounsaturated fat, moderate intakes of alcohol and low consumption of red meat, on a 0-8 scale. Relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox proportional hazards regression models.

    RESULTS: During 10 y of follow-up (1998-2008), 1109 MIs, 1648 HFs, 1270 ischemic strokes and 262 total hemorrhagic strokes were ascertained. A high adherence to the mMED score (6-8), compared to low, was associated with a lower risk of MI (RR: 0.74, 95% CI: 0.61-0.90, p = 0.003), HF (RR: 0.79, 95% CI: 0.68-0.93, p = 0.004) and ischemic stroke (RR: 0.78, 95% CI: 0.65-0.93, p = 0.007), but not hemorrhagic stroke (RR: 0.88, 95% CI: 0.61-1.29, p = 0.53).

    CONCLUSIONS: Better adherence to a Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD.

    Be well!


  10. JP Says:

    Updated 1/16/15:


    PLoS One. 2016 Jan 8;11(1):e0146462.

    Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis.

    BACKGROUND: The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown.

    METHODS: Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs.

    RESULTS: Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22-1.28) and stroke (aHR, 1.24; 95% CI, 1.16-1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults.

    CONCLUSIONS: The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.

    Be well!


  11. JP Says:

    Updated 1/16/16:


    Nutrients. 2016 Jan 4;8(1).

    Greater Total Antioxidant Capacity from Diet and Supplements Is Associated with a Less Atherogenic Blood Profile in U.S. Adults.

    Evidence from epidemiologic studies has shown that total antioxidant capacity (TAC) in the diet might be inversely associated with stroke, heart failure, and inflammatory biomarkers. However, studies on the association of TAC from both diet and supplements with cardiovascular disease (CVD) risk factors in the U.S. population are lacking. This cross-sectional population-based study aimed to investigate the association of TAC with both diet and supplements with CVD risk factors among 4039 U.S. adults in National Health and Nutrition Examination Survey (NHANES) 2007-2012. TAC from both food sources and dietary supplements was estimated from two 24-h dietary recalls using the NHANES supplement ingredient database, United States Department of Agriculture (USDA) proanthocyanidin, flavonoid, and isoflavone databases. Top contributors to TAC were tea, antioxidant supplements, vegetable mixture, orange juice, berries, and wine. Antioxidant supplement users had 1.6 times higher TAC than non-users. Greater TAC was associated with reduced triglycerides (TG) (-1.39% change; 95% CI = -2.56 to -0.21), TG to high-density lipoprotein cholesterol (HDL-C) ratio (-2.03% change; 95% CI = -3.45 to -0.60), HDL-C (0.65% change; 95% CI = 0.07 to 1.23), insulin (-1.37% change; 95% CI = -2.64 to -0.09), homeostasis model assessment of insulin resistance (HOMA-IR) (-1.57% change; 95% CI = -3.02 to -0.09) and C-reactive protein (CRP) (-0.83% change; 95% CI = -1.29 to -0.38) after adjusting for potential confounders. There was no significant association between TAC and waist circumference, BMI, blood pressure, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and fasting glucose. The findings of this study support the hypothesis that an antioxidant-rich diet and intake of supplements are beneficial to reduce CVD risk.

    Be well!


  12. JP Says:

    Updated 06/26/16:


    Evid Based Complement Alternat Med. 2016;2016:2795915.

    Effectiveness of Gotu Kola Extract 750 mg and 1000 mg Compared with Folic Acid 3 mg in Improving Vascular Cognitive Impairment after Stroke.

    This study aimed to determine the effectiveness of gotu kola (Centella asiatica) in improving cognitive function in patients with vascular cognitive impairment (VCI). This study uses a quasi-experimental design. Subjects in this study were patients with poststroke cognitive impairment who were treated at two hospitals in Yogyakarta, Indonesia. The number of subjects was 48: 17 subjects were treated with 1000 mg/day of gotu kola extract, 17 subjects treated with 750 mg/day of gotu kola extract, and 14 subjects treated with 3 mg/day of folic acid for 6 weeks. A Montreal Cognitive Assessment-Indonesian version (MoCA-Ina) was conducted at the beginning of treatment and after 6 weeks of therapy. It was found that all trials effectively improved poststroke VCI based on MoCA-Ina scores over the course of the study. There is no significant difference in ΔMoCA-Ina (score at the 6th week of treatment – score at the beginning) mean score among the three groups, indicating that gotu kola is as effective as folic acid in improving poststroke VCI. Gotu kola was shown to be more effective than folic acid in improving memory domain. This study suggested that gotu kola extract is effective in improving cognitive function after stroke.

    Be well!


  13. JP Says:

    Updated 09/23/16:


    J Nutr. 2016 Sep 21.

    Flavanone Intake Is Inversely Associated with Risk of Incident Ischemic Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

    BACKGROUND: Flavonoids may have beneficial cerebrovascular effects, but evidence from racially and geographically representative cohorts in comprehensive flavonoid databases is lacking. Given racial and geographic disparities in stroke incidence, representative cohort studies are needed.

    OBJECTIVES: We evaluated the association between flavonoid intake and incident ischemic stroke in a biracial, national cohort using updated flavonoid composition tables and assessed differences in flavonoid intake by sex, race, and region of residence.

    METHODS: We evaluated 20,024 participants in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a biracial prospective study. Participants with stroke history or missing dietary data were excluded. Flavonoid intake was estimated by using a Block98 food frequency questionnaire and the USDA’s Provisional Flavonoid Addendum and Proanthocyanidin Database. Associations between quintiles of flavonoid intake and incident ischemic stroke were evaluated by using Cox proportional hazards models, adjusting for confounders.

    RESULTS: Over 6.5 y, 524 acute ischemic strokes occurred. Flavanone intake was lower in the Southeastern United States but higher in blacks than in whites. After multivariable adjustment, flavanone intake was inversely associated with incident ischemic stroke (HR: 0.72; 95% CI: 0.55, 0.95; P-trend = 0.03). Consumption of citrus fruits and juices was inversely associated with incident ischemic stroke (HR: 0.69; 95% CI: 0.53, 0.91; P-trend = 0.02). Total flavonoids and other flavonoid subclasses were not associated with incident ischemic stroke. There was no statistical interaction with sex, race, or region for any flavonoid measure.

    CONCLUSIONS: Greater consumption of flavanones, but not total or other flavonoid subclasses, was inversely associated with incident ischemic stroke. Associations did not differ by sex, race, or region for the association; however, regional differences in flavanone intake may contribute to regional disparities in ischemic stroke incidence. Higher flavanone intake in blacks suggests that flavanone intake is not implicated in racial disparities in ischemic stroke incidence.

    Be well!


  14. JP Says:

    Updated 10/30/16:


    J Am Heart Assoc. 2016 Oct 6;5(10).

    Meta-Analysis of Potassium Intake and the Risk of Stroke.

    BACKGROUND: The possibility that lifestyle factors such as diet, specifically potassium intake, may modify the risk of stroke has been suggested by several observational cohort studies, including some recent reports. We performed a systematic review and meta-analysis of existing studies and assessed the dose-response relation between potassium intake and stroke risk.

    METHODS AND RESULTS: We reviewed the observational cohort studies addressing the relation between potassium intake, and incidence or mortality of total stroke or stroke subtypes published through August 6, 2016. We carried out a meta-analysis of 16 cohort studies based on the relative risk (RR) of stroke comparing the highest versus lowest intake categories. We also plotted a pooled dose-response curve of RR of stroke according to potassium intake. Analyses were performed with and without adjustment for blood pressure. Relative to the lowest category of potassium intake, the highest category of potassium intake was associated with a 13% reduced risk of stroke (RR=0.87, 95% CI 0.80-0.94) in the blood pressure-adjusted analysis. Summary RRs tended to decrease when original estimates were unadjusted for blood pressure. Analysis for stroke subtypes yielded comparable results. In the spline analysis, the pooled RR was lowest at 90 mmol of potassium daily intake (RRs=0.78, 95% CI 0.70-0.86) in blood pressure-adjusted analysis, and 0.67 (95% CI 0.57-0.78) in unadjusted analysis.

    CONCLUSIONS: Overall, this dose-response meta-analysis confirms the inverse association between potassium intake and stroke risk, with potassium intake of 90 mmol (≈3500 mg)/day associated with the lowest risk of stroke.

    Be well!


  15. JP Says:

    Updated 01/06/17:


    Mol Nutr Food Res. 2017 Jan 5.

    Dietary total flavonoids intake and risk of mortality from all causes and cardiovascular disease in the general population: a systematic review and meta-analysis of cohort studies.

    AIM: Epidemiologic studies assessing the association between dietary total flavonoids intake and the risk of mortality from cardiovascular disease (CVD) and all causes have yielded inconsistent results. Therefore, we conducted a dose-response meta-analysis to investigate this association.

    METHOD: We searched PubMed and Embase databases from January 1966 through May 2016 and examined the references of retrieved articles to identify relevant prospective cohort studies. The random-effect model was used to calculate the summary risk estimates and dose-response analysis was performed.

    RESULTS: Ten studies were included in the present meta-analysis. The relative risk (RR) of all-cause mortality for the highest versus lowest category of total flavonoids intake was 0.82 (95% confidence interval (CI): 0.72-0.92). Dose-response analysis showed that those consuming 200mg/d of total flavonoids had the lowest risk of all-cause mortality. Furthermore, a marginally significant association was found between dietary total flavonoids consumption and risk of death from CVD (summary RR: 0.85; 95% CI: 0.70-1.03; P = 0.099) and coronary heart diseases (CHD) (summary RR: 0.74; 95% CI: 0.54-1.02; P = 0.069), respectively.

    CONCLUSIONS: The meta-analysis provides strong evidence for the recommendation of consuming flavonoids-rich food to reduce risks of mortality from all causes as part of a healthy diet among general adults.

    Be well!


  16. JP Says:

    Updated 01/30/17:


    Am J Clin Nutr. 2017 Jan 25.

    Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention.

    BACKGROUND: Diabetes is a known risk factor for stroke, but data on its prospective association with first stroke are limited. Folic acid supplementation has been shown to protect against first stroke, but its role in preventing first stroke in diabetes is unknown.

    OBJECTIVES: This post hoc analysis of the China Stroke Primary Prevention Trial tested the hypotheses that the fasting blood glucose (FBG) concentration is positively associated with first stroke risk and that folic acid treatment can reduce stroke risk associated with elevated fasting glucose concentrations.

    DESIGN: This analysis included 20,327 hypertensive adults without a history of stroke or myocardial infarction, who were randomly assigned to a double-blind daily treatment with 10 mg enalapril and 0.8 mg folic acid (n = 10,160) or 10 mg enalapril alone (n = 10,167). Kaplan-Meier survival analysis and Cox proportionate hazard models were used to test the hypotheses with adjustment for pertinent covariables.

    RESULTS: During a median treatment duration of 4.5 y, 616 participants developed a first stroke (497 ischemic strokes). A high FBG concentration (≥7.0 mmol/L) or diabetes, compared with a low FBG concentration (<5.0 mmol/L), was associated with an increased risk of first stroke (6.0% compared with 2.6%, respectively; HR: 1.9; 95% CI: 1.3, 2.8; P < 0.001). Folic acid treatment reduced the risk of stroke across a wide range of FBG concentrations ≥5.0 mmol/L, but risk reduction was greatest in subjects with FBG concentrations ≥7.0 mmol/L or with diabetes (HR: 0.66; 95% CI: 0.46, 0.97; P < 0.05). There was a significant interactive effect of FBG and folic acid treatment on first stroke (P = 0.01). CONCLUSIONS: In Chinese hypertensive adults, an FBG concentration ≥7.0 mmol/L or diabetes is associated with an increased risk of first stroke; this increased risk is reduced by 34% with folic acid treatment. These findings warrant additional investigation. Be well! JP

Leave a Comment