An unfavorable dietary pattern is associated with symptomatic ischemic stroke and carotid atherosclerosis.
OBJECTIVE
Ischemic strokes represent more than 80% of total strokes in Western countries. The influence of dietary factors on ischemic stroke risk is debated mainly because available data are limited. Our objective was to compare the dietary pattern of symptomatic ischemic stroke patients under 65 years old with control subjects using a validated 14-item food frequency questionnaire (FFQ). We also compared symptomatic ischemic stroke patients with carotid atherosclerosis with those without according to the presence or the absence of carotid plaque defined by duplex scanning.


METHODS
This was a case-control multi-center study that took place in one University hospital and two general hospitals in France. One hundred twenty-four symptomatic ischemic stroke patients (confirmation by a neurologist and imaging; 66% smokers) and 50 controls (34% smokers) without any known cardiovascular disease or previous nutritional advice were included. The main outcome measure(s) were intake scores for saturated (SFA), monounsaturated (MUFA), Omega-3 polyunsaturated (Omega-3 PUFA), and Omega-6 polyunsaturated fatty acids (Omega-6PUFA). Fruit and vegetables and an overall cardiovascular dietary score were evaluated with the FFQ. The overall cardiovascular score is calculated as (MUFA + Omega-3 PUFA + fruits and vegetables) - (SFA) scores.


RESULTS
Compared with controls, ischemic stroke patients had a higher SFA score (6.6 +/- 3.0 vs 4.9 +/- 2.7; P < .001), lower scores of MUFA (0.8 +/- 0.9 vs 1.5 +/- 1.2; P < .001), Omega-3 PUFA (1.7 +/- 1.6 vs 2.2 +/- 1.5; P = .013), Omega-6PUFA (2.6 +/- 2.5 vs 3.9 +/- 2.7; P = .002), fruit and vegetables (2.9 +/- 1.7 vs 3.8 +/- 1.6; P = .005), and a lower overall dietary score (-1.2 +/- 5.0 vs 2.5 +/- 4.4; P < .001). These results remained statistically significant after adjustment for age, gender, and smoking status. Ischemic stroke patients with carotid atherosclerosis (n = 54) had a worse overall cardiovascular dietary score than those without (n = 68): -2.2 +/- 4.4 vs -0.2 +/- 5.2; P = .024.


CONCLUSIONS
Compared with controls, ischemic stroke patients, especially those with carotid atherosclerosis, have an unfavorable dietary pattern (high SFA, low fruit and vegetables, and Omega-3 PUFA consumptions) that may have been a facilitating condition of the ischemic stroke. Dietary recommendations of a healthy diet should be useful in ischemic stroke prevention, especially in patients with cardiovascular risk factors.
Laboratory of Vascular investigations, Centre National de la Recherche Scientifique UMR6214/INSERM Unité 771, Rennes, France.
Guillaume
G
Mahe
Thomas
T
Ronziere
Bruno
B
Laviolle
Véronique
V
Golfier
Thomas
T
Cochery
Jean-Michel
JM
De Bray
François
F
Paillard
D000328:Adult; D002545:Brain Ischemia / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D016022:Case-Control Studies; D004032:Diet / Q000009:adverse effects*; D015930:Diet Records; D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005247:Feeding Behavior; D005260:Female; D005602:France; D005638:Fruit; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D018616:Ultrasonography, Doppler, Duplex; D014675:Vegetables
D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6