title: Dietary exposure to polychlorinated biphenyls is associated with increased risk of stroke in women.
abstract: OBJECTIVE
  The potentially beneficial effects of fish consumption on stroke may be modified by major food contaminants in fish. Polychlorinated biphenyls (PCBs) in particular are proposed to play a role in the aetiology of stroke. The aim of this study was to assess the association between dietary PCB exposure and stroke risk with the intake of long-chain omega-3 fish fatty acids and fish consumption.
  
  
  METHODS
  The prospective population-based Swedish Mammography Cohort was examined. It was comprised of 34,591 women free of cardiovascular diseases and cancer at baseline in 1997 and followed up for 12 years. Validated estimates of dietary PCB exposure were obtained via a food frequency questionnaire at baseline. Incident cases of stroke were ascertained through register linkage.
  
  
  RESULTS
  During 12 years of follow-up (397,309 person-years), there were 2015 incident cases of total stroke (1532 ischaemic strokes, 216 intracerebral haemorrhages, 94 subarachnoid haemorrhages and 173 unspecified strokes). Multivariable-adjusted relative risks (RR), controlled for known stroke risk factors and fish consumption, were 1.67 [95% confidence interval (CI), 1.29-2.17] for total stroke, 1.61 (95% CI, 1.19-2.17) for ischaemic stroke and 2.80 (95% CI, 1.42-5.55) for haemorrhagic stroke for women in the highest quartile of dietary PCB exposure (median 288 ng day(-1) ) compared with women in the lowest quartile (median 101 ng day(-1) ).
  
  
  CONCLUSIONS
  Dietary exposure to PCBs was associated with an increased stroke risk in women, especially haemorrhagic stroke. The results provide important information regarding the risk-benefit analysis of fish consumption, particularly for cerebrovascular disease prevention.
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Bergkvist
authors.forename: M
authors.initials: M
authors.lastname: Kippler
authors.forename: S C
authors.initials: SC
authors.lastname: Larsson
authors.forename: M
authors.initials: M
authors.lastname: Berglund
authors.forename: A
authors.initials: A
authors.lastname: Glynn
authors.forename: A
authors.initials: A
authors.lastname: Wolk
authors.forename: A
authors.initials: A
authors.lastname: Åkesson
mesh_terms: D004032:Diet / Q000009:adverse effects*; D015525:Fatty Acids, Omega-3 / Q000633:toxicity*; D005260:Female; D005506:Food Contamination; D006801:Humans; D008875:Middle Aged; D011078:Polychlorinated Biphenyls / Q000633:toxicity*; D011446:Prospective Studies; D012307:Risk Factors; D017747:Seafood / Q000009:adverse effects*; D020521:Stroke / Q000139:chemically induced*
chemical_list: D015525:Fatty Acids, Omega-3; D011078:Polychlorinated Biphenyls
keywords: food intake; polychlorinated biphenyls; stroke