Semin Neurol 2006; 26(1): 011-023
DOI: 10.1055/s-2006-933305
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Optimal Dietary Habits for the Prevention of Stroke

Eric L. Ding1 , 2 , Dariush Mozaffarian1 , 3
  • 1Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts
  • 2Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
  • 3Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Further Information

Publication History

Publication Date:
15 February 2006 (online)

ABSTRACT

Diet may influence stroke risk via several mechanisms, but the optimal dietary habits for stroke prevention are not well established. We reviewed English-language MEDLINE publications from January 1979 through November 2004 for experimental, observational, and clinical studies of dietary factors (minerals, fats, cholesterol, fish, animal protein, fiber, whole grains, carbohydrate quality, fruits and vegetables, antioxidants, B vitamins, dietary patterns) and risk of stroke or hypertension, the principal modifiable stroke risk factor. A total of 121 publications were selected based on relevance and quality of design and methods. Diets low in sodium and high in potassium lower blood pressure which will likely reduce stroke risk. Consumption of fruits and vegetables, whole grains, folate, and fatty fish are each likely to reduce stroke risk. A prudent or traditional Mediterranean dietary pattern, which incorporates these individual dietary components as well as intake of legumes and olive oil, may also prevent stroke. Evidence is limited or inconsistent regarding optimal levels of dietary magnesium, calcium, antioxidants, total fat, other fat subtypes, cholesterol, carbohydrate quality, or animal protein for stroke prevention. A diet low in sodium, high in potassium, and rich in fruits, vegetables, whole grains, cereal fiber, and fatty fish will likely reduce the incidence of stroke. Further research is needed regarding the possible effects of other major dietary factors on stroke risk.

REFERENCES

  • 1 Mackay J, Mensah G. The Atlas of Heart Disease and Stroke. The World Health Organization. WHO 2004 Available at: http://www.who.int/cardiovascular_diseases/resources/atlas/en/ Accessed December 2004
  • 2 Gorelick P B. Stroke prevention. An opportunity for efficient utilization of health care resources during the coming decade.  Stroke. 1994;  25 220-224
  • 3 American Heart Association .Heart Disease and Stroke Statistics: 2004 Update. Dallas, TX; American Heart Association 2003
  • 4 Bonow R O, Smaha L A, Smith Jr S C, Mensah G A, Lenfant C. World Heart Day 2002: the international burden of cardiovascular disease: responding to the emerging global epidemic.  Circulation. 2002;  106 1602-1605
  • 5 Mensah G A. The global burden of hypertension: good news and bad news.  Cardiol Clin. 2002;  20 181-185
  • 6 The Victoria Declaration on Heart Health .Declaration of the Advisory Board, International Health Conference, May 28, 1992. Health and Welfare Canada. 1992 Available at: http://www.med.mun.ca/chhdbc/pdf/victr_e.pdf Accessed November 21, 2004
  • 7 U.S. Preventive Services Task Force .Guide to Clinical Preventive Services: Report of the U.S. Preventive Services Task Force. Vol xcii Baltimore, MD; Williams & Wilkins 1996
  • 8 Eyre H, Kahn R, Robertson R M et al.. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association.  Stroke. 2004;  35 1999-2010
  • 9 Goldstein L B, Adams R, Becker K et al.. Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association.  Stroke. 2001;  32 280-299
  • 10 Gorelick P B, Sacco R L, Smith D B et al.. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association.  JAMA. 1999;  281 1112-1120
  • 11 Preventing Obesity and Chronic Diseases Through Good Nutrition and Physical Activity .National Center for Chronic Disease Prevention and Health Promotion. August 2003. Available at: http://www.cdc.gov/nccdphp/pe_factsheets/pe_pa.htm Accessed December 10, 2004
  • 12 Hajjar I M, Grim C E, George V, Kotchen T A. Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III.  Arch Intern Med. 2001;  161 589-593
  • 13 Stamler J, Rose G, Elliott P et al.. Findings of the International Cooperative INTERSALT Study.  Hypertension. 1991;  17 I9-15
  • 14 Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M. INTERSALT study findings: public health and medical care implications.  Hypertension. 1989;  14 570-577
  • 15 Hofman A, Hazebroek A, Valkenburg H A. A randomized trial of sodium intake and blood pressure in newborn infants.  JAMA. 1983;  250 370-373
  • 16 Geleijnse J M, Hofman A, Witteman J C, Hazebroek A A, Valkenburg H A, Grobbee D E. Long-term effects of neonatal sodium restriction on blood pressure.  Hypertension. 1997;  29 913-917
  • 17 Sacks F M, Svetkey L P, Vollmer W M et al.. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.  N Engl J Med. 2001;  344 3-10
  • 18 Sasaki S, Zhang X H, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality.  Stroke. 1995;  26 783-789
  • 19 He J, Ogden L G, Vupputuri S, Bazzano L A, Loria C, Whelton P K. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults.  JAMA. 1999;  282 2027-2034
  • 20 Nagata C, Takatsuka N, Shimizu N, Shimizu H. Sodium intake and risk of death from stroke in Japanese men and women.  Stroke. 2004;  35 1543-1547
  • 21 Geleijnse J M, Grobbee D E, Hofman A. Sodium and potassium intake and blood pressure change in childhood.  BMJ. 1990;  300 899-902
  • 22 Simons-Morton D G, Hunsberger S A, Van Horn L et al.. Nutrient intake and blood pressure in the Dietary Intervention Study in Children.  Hypertension. 1997;  29 930-936
  • 23 Ascherio A, Hennekens C, Willett W C et al.. Prospective study of nutritional factors, blood pressure, and hypertension among US women.  Hypertension. 1996;  27 1065-1072
  • 24 Ascherio A, Rimm E B, Giovannucci E L et al.. A prospective study of nutritional factors and hypertension among US men.  Circulation. 1992;  86 1475-1484
  • 25 Joffres M R, Reed D M, Yano K. Relationship of magnesium intake and other dietary factors to blood pressure: the Honolulu heart study.  Am J Clin Nutr. 1987;  45 469-475
  • 26 Whelton P K, He J, Cutler J A et al.. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials.  JAMA. 1997;  277 1624-1632
  • 27 Ascherio A, Rimm E B, Hernan M A et al.. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men.  Circulation. 1998;  98 1198-1204
  • 28 Bazzano L A, He J, Ogden L G et al.. Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study.  Stroke. 2001;  32 1473-1480
  • 29 Green D M, Ropper A H, Kronmal R A, Psaty B M, Burke G L. Serum potassium level and dietary potassium intake as risk factors for stroke.  Neurology. 2002;  59 314-320
  • 30 Iso H, Stampfer M J, Manson J E et al.. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women.  Stroke. 1999;  30 1772-1779
  • 31 Khaw K T, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study.  N Engl J Med. 1987;  316 235-240
  • 32 Witteman J C, Willett W C, Stampfer M J et al.. A prospective study of nutritional factors and hypertension among US women.  Circulation. 1989;  80 1320-1327
  • 33 Itoh K, Kawasaka T, Nakamura M. The effects of high oral magnesium supplementation on blood pressure, serum lipids and related variables in apparently healthy Japanese subjects.  Br J Nutr. 1997;  78 737-750
  • 34 Sanjuliani A F, de Abreu Fagundes V G, Francischetti E A. Effects of magnesium on blood pressure and intracellular ion levels of Brazilian hypertensive patients.  Int J Cardiol. 1996;  56 177-183
  • 35 Widman L, Wester P O, Stegmayr B K, Wirell M. The dose-dependent reduction in blood pressure through administration of magnesium. A double blind placebo controlled cross-over study.  Am J Hypertens. 1993;  6 41-45
  • 36 Witteman J C, Grobbee D E, Derkx F H, Bouillon R, de Bruijn A M, Hofman A. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension.  Am J Clin Nutr. 1994;  60 129-135
  • 37 Cappuccio F P, Markandu N D, Beynon G W, Shore A C, Sampson B, MacGregor G A. Lack of effect of oral magnesium on high blood pressure: a double blind study.  Br Med J (Clin Res Ed). 1985;  291 235-238
  • 38 Doyle L, Flynn A, Cashman K. The effect of magnesium supplementation on biochemical markers of bone metabolism or blood pressure in healthy young adult females.  Eur J Clin Nutr. 1999;  53 255-261
  • 39 Plum-Wirell M, Stegmayr B G, Wester P O. Nutritional magnesium supplementation does not change blood pressure nor serum or muscle potassium and magnesium in untreated hypertension. A double-blind crossover study.  Magnes Res. 1994;  7 277-283
  • 40 Sacks F M, Willett W C, Smith A, Brown L E, Rosner B, Moore T J. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake.  Hypertension. 1998;  31 131-138
  • 41 Wirell M P, Wester P O, Stegmayr B G. Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study.  J Intern Med. 1994;  236 189-195
  • 42 Yamamoto M E, Applegate W B, Klag M J et al.. Lack of blood pressure effect with calcium and magnesium supplementation in adults with high-normal blood pressure. Results from Phase I of the Trials of Hypertension Prevention (TOHP). Trials of Hypertension Prevention (TOHP) Collaborative Research Group.  Ann Epidemiol. 1995;  5 96-107
  • 43 Lind L, Lithell H, Pollare T, Ljunghall S. Blood pressure response during long-term treatment with magnesium is dependent on magnesium status. A double-blind, placebo-controlled study in essential hypertension and in subjects with high-normal blood pressure.  Am J Hypertens. 1991;  4 674-679
  • 44 Jorde R, Bonaa K H. Calcium from dairy products, vitamin D intake, and blood pressure: the Tromso Study.  Am J Clin Nutr. 2000;  71 1530-1535
  • 45 Abbott R D, Curb J D, Rodriguez B L, Sharp D S, Burchfiel C M, Yano K. Effect of dietary calcium and milk consumption on risk of thromboembolic stroke in older middle-aged men. The Honolulu Heart Program.  Stroke. 1996;  27 813-818
  • 46 McGee D, Reed D, Stemmerman G, Rhoads G, Yano K, Feinleib M. The relationship of dietary fat and cholesterol to mortality in 10 years: the Honolulu Heart Program.  Int J Epidemiol. 1985;  14 97-105
  • 47 Reed D M. The paradox of high risk of stroke in populations with low risk of coronary heart disease.  Am J Epidemiol. 1990;  131 579-588
  • 48 Gillman M W, Cupples L A, Millen B E, Ellison R C, Wolf P A. Inverse association of dietary fat with development of ischemic stroke in men.  JAMA. 1997;  278 2145-2150
  • 49 He K, Merchant A, Rimm E B et al.. Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study.  BMJ. 2003;  327 777-782
  • 50 Iso H, Stampfer M J, Manson J E et al.. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women.  Circulation. 2001;  103 856-863
  • 51 Iso H, Sato S, Kitamura A, Naito Y, Shimamoto T, Komachi Y. Fat and protein intakes and risk of intraparenchymal hemorrhage among middle-aged Japanese.  Am J Epidemiol. 2003;  157 32-39
  • 52 Sauvaget C, Nagano J, Allen N, Grant E J, Beral V. Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study.  Int J Epidemiol. 2003;  32 536-543
  • 53 Sauvaget C, Nagano J, Hayashi M, Yamada M. Animal protein, animal fat, and cholesterol intakes and risk of cerebral infarction mortality in the adult health study.  Stroke. 2004;  35 1531-1537
  • 54 Iso H, Sato S, Umemura U et al.. Linoleic acid, other fatty acids, and the risk of stroke.  Stroke. 2002;  33 2086-2093
  • 55 Djousse L, Folsom A R, Province M A, Hunt S C, Ellison R C. Dietary linolenic acid and carotid atherosclerosis: the National Heart, Lung, and Blood Institute Family Heart Study.  Am J Clin Nutr. 2003;  77 819-825
  • 56 Simon J A, Fong J, Bernert Jr J T, Browner W S. Serum fatty acids and the risk of stroke.  Stroke. 1995;  26 778-782
  • 57 Hu F B, Stampfer M J, Rimm E B et al.. A prospective study of egg consumption and risk of cardiovascular disease in men and women.  JAMA. 1999;  281 1387-1394
  • 58 Agren J J, Hanninen O, Hanninen A, Seppanen K. Dose responses in platelet fatty acid composition, aggregation and prostanoid metabolism during moderate freshwater fish diet.  Thromb Res. 1990;  57 565-575
  • 59 Kromann N, Green A. Epidemiological studies in the Upernavik district, Greenland. Incidence of some chronic diseases 1950-1974.  Acta Med Scand. 1980;  208 401-406
  • 60 Middaugh J P. Cardiovascular deaths among Alaskan Natives, 1980-86.  Am J Public Health. 1990;  80 282-285
  • 61 Parkinson A J, Cruz A L, Heyward W L et al.. Elevated concentrations of plasma omega-3 polyunsaturated fatty acids among Alaskan Eskimos.  Am J Clin Nutr. 1994;  59 384-388
  • 62 Knapp H R, Reilly I A, Alessandrini P, FitzGerald G A. In vivo indexes of platelet and vascular function during fish-oil administration in patients with atherosclerosis.  N Engl J Med. 1986;  314 937-942
  • 63 Ellis E F, Police R J, Dodson L Y, McKinney J S, Holt S A. Effect of dietary n-3 fatty acids on cerebral microcirculation.  Am J Physiol. 1992;  262 H1379-H1386
  • 64 Howe P R, Lungershausen Y K, Rogers P F, Gerkens J F, Head R J, Smith R M. Effects of dietary sodium and fish oil on blood pressure development in stroke-prone spontaneously hypertensive rats.  J Hypertens. 1991;  9 639-644
  • 65 Knapp H R. n-3 fatty acids and human hypertension.  Curr Opin Lipidol. 1996;  7 30-33
  • 66 Nestel P J. Fish oil and cardiovascular disease: lipids and arterial function.  Am J Clin Nutr. 2000;  71 228S-231S
  • 67 Smith J M, Paulson D J, Labak S. Effects of dietary fish oil on Rb+ efflux from aorta of stroke prone spontaneously hypertensive rats.  Am J Hypertens. 1992;  5 473-479
  • 68 Cobiac L, Nestel P J, Wing L M, Howe P R. A low-sodium diet supplemented with fish oil lowers blood pressure in the elderly.  J Hypertens. 1992;  10 87-92
  • 69 Bjerregaard P, Dyerberg J. Mortality from ischaemic heart disease and cerebrovascular disease in Greenland.  Int J Epidemiol. 1988;  17 514-519
  • 70 Caicoya M. Fish consumption and stroke: a community case-control study in Asturias, Spain.  Neuroepidemiology. 2002;  21 107-114
  • 71 Hunter D J, Kazda I, Chockalingam A, Fodor J G. Fish consumption and cardiovascular mortality in Canada: an inter-regional comparison.  Am J Prev Med. 1988;  4 5-10
  • 72 Jamrozik K, Broadhurst R J, Anderson C S, Stewart-Wynne E G. The role of lifestyle factors in the etiology of stroke. A population-based case-control study in Perth, Western Australia.  Stroke. 1994;  25 51-59
  • 73 Zhang J, Sasaki S, Amano K, Kesteloot H. Fish consumption and mortality from all causes, ischemic heart disease, and stroke: an ecological study.  Prev Med. 1999;  28 520-529
  • 74 He K, Song Y, Daviglus M L et al.. Fish consumption and incidence of stroke: a meta-analysis of cohort studies.  Stroke. 2004;  35 1538-1542
  • 75 Mozaffarian D, Longstreth Jr W T, Lemaitre R N et al.. Fish consumption and stroke risk in elderly individuals: the cardiovascular health study.  Arch Intern Med. 2005;  165 200-206
  • 76 Burr M L, Fehily A M, Gilbert J F et al.. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART).  Lancet. 1989;  2 757-761
  • 77 Ness A R, Ashfield-Watt P A, Whiting J M, Smith G D, Hughes J, Burr M L. The long-term effect of dietary advice on the diet of men with angina: the diet and angina randomized trial.  J Hum Nutr Diet. 2004;  17 117-119
  • 78 Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. . Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial.  Lancet. 1999;  354 447-455
  • 79 Zhou B, Zhang X, Zhu A et al.. The relationship of dietary animal protein and electrolytes to blood pressure: a study on three Chinese populations.  Int J Epidemiol. 1994;  23 716-722
  • 80 Appel L J, Moore T J, Obarzanek E et al.. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.  N Engl J Med. 1997;  336 1117-1124
  • 81 Kinjo Y, Beral V, Akiba S et al.. Possible protective effect of milk, meat and fish for cerebrovascular disease mortality in Japan.  J Epidemiol. 1999;  9 268-274
  • 82 Anderson J W. Dietary fiber prevents carbohydrate-induced hypertriglyceridemia.  Curr Atheroscler Rep. 2000;  2 536-541
  • 83 Burke V, Hodgson J M, Beilin L J, Giangiulioi N, Rogers P, Puddey I B. Dietary protein and soluble fiber reduce ambulatory blood pressure in treated hypertensives.  Hypertension. 2001;  38 821-826
  • 84 Pereira M A, Pins J J. Dietary fiber and cardiovascular disease: experimental and epidemiologic advances.  Curr Atheroscler Rep. 2000;  2 494-502
  • 85 Jenkins D J. Dietary carbohydrates and their glycemic responses.  JAMA. 1984;  251 2829-2831
  • 86 Pereira M A, Swain J, Goldfine A B, Rifai N, Ludwig D S. Effects of a low-glycemic load diet on resting energy expenditure and heart disease risk factors during weight loss.  JAMA. 2004;  292 2482-2490
  • 87 Slavin J, Jacobs D, Marquart L. Whole-grain consumption and chronic disease: protective mechanisms.  Nutr Cancer. 1997;  27 14-21
  • 88 Ludwig D S. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease.  JAMA. 2002;  287 2414-2423
  • 89 Oh K, Hu F B, Cho E et al.. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women.  Am J Epidemiol. 2005;  161 161-169
  • 90 Mozaffarian D, Kumanyika S K, Lemaitre R N, Olson J L, Burke G L, Siscovick D S. Cereal, fruit, and vegetable fiber intake and the risk of cardiovascular disease in elderly individuals.  JAMA. 2003;  289 1659-1666
  • 91 Liu S, Manson J E, Stampfer M J et al.. Whole grain consumption and risk of ischemic stroke in women: a prospective study.  JAMA. 2000;  284 1534-1540
  • 92 Steffen L M, Jacobs Jr D R, Stevens J, Shahar E, Carithers T, Folsom A R. Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study.  Am J Clin Nutr. 2003;  78 383-390
  • 93 Liu S, Willett W C. Dietary glycemic load and atherothrombotic risk.  Curr Atheroscler Rep. 2002;  4 454-461
  • 94 Alonso A, de la Fuente C, Martin-Arnau A M, de Irala J, Martinez J A, Martinez-Gonzalez M A. Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study.  Br J Nutr. 2004;  92 311-319
  • 95 Gillman M W, Cupples L A, Gagnon D et al.. Protective effect of fruits and vegetables on development of stroke in men.  JAMA. 1995;  273 1113-1117
  • 96 Johnsen S P, Overvad K, Stripp C, Tjonneland A, Husted S E, Sorensen H T. Intake of fruit and vegetables and the risk of ischemic stroke in a cohort of Danish men and women.  Am J Clin Nutr. 2003;  78 57-64
  • 97 Joshipura K J, Ascherio A, Manson J E et al.. Fruit and vegetable intake in relation to risk of ischemic stroke.  JAMA. 1999;  282 1233-1239
  • 98 Sauvaget C, Nagano J, Allen N, Kodama K. Vegetable and fruit intake and stroke mortality in the Hiroshima/Nagasaki Life Span Study.  Stroke. 2003;  34 2355-2360
  • 99 Giugliano D. Dietary antioxidants for cardiovascular prevention.  Nutr Metab Cardiovasc Dis. 2000;  10 38-44
  • 100 Leppala J M, Virtamo J, Fogelholm R et al.. Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers.  Arterioscler Thromb Vasc Biol. 2000;  20 230-235
  • 101 Mark S D, Wang W, Fraumeni Jr J F et al.. Do nutritional supplements lower the risk of stroke or hypertension?.  Epidemiology. 1998;  9 9-15
  • 102 Eidelman R S, Hollar D, Hebert P R, Lamas G A, Hennekens C H. Randomized trials of vitamin E in the treatment and prevention of cardiovascular disease.  Arch Intern Med. 2004;  164 1552-1556
  • 103 Keli S O, Hertog M G, Feskens E J, Kromhout D. Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study.  Arch Intern Med. 1996;  156 637-642
  • 104 Daviglus M L, Orencia A J, Dyer A R et al.. Dietary vitamin C, beta-carotene and 30-year risk of stroke: results from the Western Electric Study.  Neuroepidemiology. 1997;  16 69-77
  • 105 Hirvonen T, Virtamo J, Korhonen P, Albanes D, Pietinen P. Intake of flavonoids, carotenoids, vitamins C and E, and risk of stroke in male smokers.  Stroke. 2000;  31 2301-2306
  • 106 Yochum L A, Folsom A R, Kushi L H. Intake of antioxidant vitamins and risk of death from stroke in postmenopausal women.  Am J Clin Nutr. 2000;  72 476-483
  • 107 Yokoyama T, Date C, Kokubo Y, Yoshiike N, Matsumura Y, Tanaka H. Serum vitamin C concentration was inversely associated with subsequent 20-year incidence of stroke in a Japanese rural community. The Shibata study.  Stroke. 2000;  31 2287-2294
  • 108 Heart Protection Study Collaborative Group . Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial.  Lancet. 2002;  360 23-33
  • 109 Yochum L, Kushi L H, Meyer K, Folsom A R. Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women.  Am J Epidemiol. 1999;  149 943-949
  • 110 Sesso H D, Gaziano J M, Liu S, Buring J E. Flavonoid intake and the risk of cardiovascular disease in women.  Am J Clin Nutr. 2003;  77 1400-1408
  • 111 Verhaar M C, Stroes E, Rabelink T J. Folates and cardiovascular disease.  Arterioscler Thromb Vasc Biol. 2002;  22 6-13
  • 112 Bautista L E, Arenas I A, Penuela A, Martinez L X. Total plasma homocysteine level and risk of cardiovascular disease: a meta-analysis of prospective cohort studies.  J Clin Epidemiol. 2002;  55 882-887
  • 113 Boushey C J, Beresford S A, Omenn G S, Motulsky A G. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes.  JAMA. 1995;  274 1049-1057
  • 114 Homocysteine Studies Collaboration . Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis.  JAMA. 2002;  288 2015-2022
  • 115 Wald D S, Law M, Morris J K. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis.  BMJ. 2002;  325 1202-1206
  • 116 Bazzano L A, He J, Ogden L G et al.. Dietary intake of folate and risk of stroke in US men and women: NHANES I Epidemiologic Follow-up Study. National Health and Nutrition Examination Survey.  Stroke. 2002;  33 1183-1188
  • 117 He K, Merchant A, Rimm E B et al.. Folate, vitamin B6, and B12 intakes in relation to risk of stroke among men.  Stroke. 2004;  35 169-174
  • 118 Al-Delaimy W K, Rexrode K M, Hu F B et al.. Folate intake and risk of stroke among women.  Stroke. 2004;  35 1259-1263
  • 119 Toole J F, Malinow M R, Chambless L E et al.. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial.  JAMA. 2004;  291 565-575
  • 120 Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).  JAMA. 2002;  288 2981-2997
  • 121 Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study.  Am J Clin Nutr. 2004;  80 1012-1018
  • 122 Esposito K, Marfella R, Ciotola M et al.. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial.  JAMA. 2004;  292 1440-1446
  • 123 de Lorgeril M, Salen P, Martin J L, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.  Circulation. 1999;  99 779-785
  • 124 Fung T T, Stampfer M J, Manson J E, Rexrode K M, Willett W C, Hu F B. Prospective study of major dietary patterns and stroke risk in women.  Stroke. 2004;  35 2014-2019
  • 125 Hu F B, Rimm E, Smith-Warner S A et al.. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire.  Am J Clin Nutr. 1999;  69 243-249
  • 126 Bissoli L, Di Francesco V, Ballarin A et al.. Effect of vegetarian diet on homocysteine levels.  Ann Nutr Metab. 2002;  46 73-79
  • 127 Mezzano D, Munoz X, Martinez C et al.. Vegetarians and cardiovascular risk factors: hemostasis, inflammatory markers and plasma homocysteine.  Thromb Haemost. 1999;  81 913-917
  • 128 Thorogood M, Carter R, Benfield L, McPherson K, Mann J I. Plasma lipids and lipoprotein cholesterol concentrations in people with different diets in Britain.  BMJ. 1987;  295 351-353
  • 129 Margetts B M, Beilin L J, Vandongen R, Armstrong B K. Vegetarian diet in mild hypertension: a randomised controlled trial.  BMJ. 1986;  293 1468-1471
  • 130 Rouse I L, Beilin L J, Armstrong B K, Vandongen R. Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects.  Lancet. 1983;  1 5-10
  • 131 Key T J, Fraser G E, Thorogood M et al.. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies.  Am J Clin Nutr. 1999;  70 516S-524S

Dariush MozaffarianM.D. M.P.H. 

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