title: Adherence to a Mediterranean diet and prediction of incident stroke.
abstract: OBJECTIVE
  There are limited data on the potential association of adherence to Mediterranean diet (MeD) with incident stroke. We sought to assess the longitudinal association between greater adherence to MeD and risk of incident stroke.
  
  
  METHODS
  We prospectively evaluated a population-based cohort of 30 239 individuals enrolled in REasons for Geographic and Racial Differences in Stroke (REGARDS) study, after excluding participants with stroke history, missing demographic data or food frequency questionnaires, and unavailable follow-up information. Adherence to MeD was categorized using MeD score. Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years.
  
  
  RESULTS
  Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke [IS] and hemorrhagic stroke, respectively) of 20 197 individuals fulfilling the inclusion criteria. High adherence to MeD (MeD score, 5-9) was associated with lower risk of incident IS in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70-1.00; P=0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65-0.96; P=0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When MeD was evaluated as a continuous variable, a 1-point increase in MeD score was independently associated with a 5% reduction in the risk of incident IS (95% confidence interval, 0-11%). We documented no association of adherence to MeD with incident hemorrhagic stroke. There was no interaction of race (P=0.37) on the association of adherence to MeD with incident IS.
  
  
  CONCLUSIONS
  High adherence to MeD seems to be associated with a lower risk of incident IS independent of potential confounders. Adherence to MeD is not related to the risk of incident hemorrhagic stroke.
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.). tsivgoulisgiorg@yahoo.gr.
authors: Georgios
authors: G
authors: Tsivgoulis
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Theodora
authors: T
authors: Psaltopoulou
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Virginia G
authors: VG
authors: Wadley
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Andrei V
authors: AV
authors: Alexandrov
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: George
authors: G
authors: Howard
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Frederick W
authors: FW
authors: Unverzagt
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Claudia
authors: C
authors: Moy
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Virginia J
authors: VJ
authors: Howard
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Brett
authors: B
authors: Kissela
authors: From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
authors: Suzanne E
authors: SE
authors: Judd
mesh_terms: D000368:Aged; D000886:Anthropometry; D038441:Diet, Mediterranean; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires
keywords: diet, Mediterranean; hemorrhagic disorders; patient adherence; stroke; transient ischemic attack
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