Observational study finds higher diet scores associated with 18% lower stroke risk — Evidence Review
Published in Neurology Open Access, by researchers from City of Hope Comprehensive Cancer Center
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Table of Contents
Women who closely follow a Mediterranean-style diet have a lower risk of stroke, according to a large observational study. Related research consistently supports the association between healthy dietary patterns and reduced stroke risk, aligning with these findings published in Neurology Open Access.
- Multiple large cohort and systematic review studies report that adherence to Mediterranean, DASH, or other healthy dietary patterns is linked to lower risk of stroke and other cardiovascular outcomes in women and broader populations 1 2 8 11 14.
- Prior research finds that healthy dietary patterns, especially those rich in fruits, vegetables, whole grains, and healthy fats, are associated with both reduced ischemic and, in some cases, hemorrhagic stroke 2 4 8.
- Evidence from related studies suggests that overall lifestyle factors—including diet, physical activity, and smoking cessation—work synergistically to reduce stroke risk, further supporting dietary modification as a key prevention strategy 3 5 12 13.
Study Overview and Key Findings
This study explores the relationship between adherence to a Mediterranean diet and the risk of stroke among women, using data from over 100,000 participants with up to 21 years of follow-up. The research is especially notable for its large sample size and its differentiation between ischemic and hemorrhagic strokes, an area less frequently examined in previous large-scale studies. By focusing exclusively on women without a prior history of stroke, the study offers insights into primary prevention and addresses a population that is often underrepresented in cardiovascular research.
| Property | Value |
|---|---|
| Study Year | 2026 |
| Organization | City of Hope Comprehensive Cancer Center |
| Journal Name | Neurology Open Access |
| Authors | Sophia S. Wang, PhD |
| Population | Women with no history of stroke |
| Sample Size | n=105,614 |
| Methods | Observational Study |
| Outcome | Stroke incidence, including ischemic and hemorrhagic strokes |
| Results | Women with highest diet scores were 18% less likely to have a stroke |
Literature Review: Related Studies
To contextualize these findings, we conducted a literature review using the Consensus paper database, which contains over 200 million research papers. The following search queries were used to identify relevant studies:
- diet stroke risk women
- healthy diet stroke prevention
- dietary patterns cardiovascular health outcomes
Summary Table of Key Topics and Findings
| Topic | Key Findings |
|---|---|
| How do healthy dietary patterns affect stroke and cardiovascular risk in women? | - Adherence to Mediterranean, DASH, and prudent dietary patterns is consistently associated with reduced risk of stroke and cardiovascular disease in women 1 2 4 8 11 14. - Large cohort studies and systematic reviews find a significant inverse relationship between diet quality and both ischemic and hemorrhagic stroke, although effects may be stronger for ischemic events 2 4 5 6 8. |
| What are the specific components of diets linked to lower stroke risk? | - Diets high in fruits, vegetables, legumes, fish, whole grains, and healthy fats (such as olive oil) and low in red/processed meats, refined grains, and added sugars are associated with lower stroke risk 2 4 9 14. - The Mediterranean diet and DASH diet, in particular, are characterized by these components and are repeatedly shown to reduce cardiovascular and stroke risk 1 2 10 14. |
| How do dietary patterns compare to other lifestyle factors in stroke prevention? | - Healthy lifestyle factors—such as not smoking, regular physical activity, and maintaining a healthy weight—combined with a healthy diet, further reduce stroke risk compared to diet alone 3 5 12 13. - Studies estimate that a substantial proportion of strokes can be prevented by adhering to multiple low-risk lifestyle behaviors, including diet 3 5 12. |
| Are there differences in the impact of diet on ischemic vs. hemorrhagic stroke? | - Most research finds stronger associations between healthy diet patterns and reduced ischemic stroke risk, with some studies showing less clear or non-significant effects for hemorrhagic stroke 5 6. - Recent studies, including the new study, indicate possible benefits for both types of stroke, suggesting the need for further investigation into dietary effects on hemorrhagic stroke 2 4 8. |
How do healthy dietary patterns affect stroke and cardiovascular risk in women?
A substantial body of evidence supports the association between healthy dietary patterns and lower risk of stroke and cardiovascular disease among women. The new study's findings are consistent with prior research demonstrating that diets such as the Mediterranean and DASH patterns are linked to meaningful reductions in both total and ischemic stroke risk. While some variability exists regarding hemorrhagic stroke, the overall consensus is that dietary habits play a key role in primary prevention.
- Large prospective cohort studies in women consistently show that higher adherence to Mediterranean and DASH diets is associated with lower risk of stroke and coronary heart disease 1 2.
- Systematic reviews and umbrella reviews confirm that Mediterranean and similar high-quality diets reduce cardiovascular disease incidence 8 10 11 14.
- The magnitude of risk reduction in the new study (18% lower risk) aligns with previous estimates from large cohorts and meta-analyses 2 8 11.
- While some studies focus on cardiovascular disease broadly, stroke-specific outcomes are consistently improved among women following these dietary patterns 1 2 4 14.
What are the specific components of diets linked to lower stroke risk?
The protective effects of dietary patterns are attributed to specific components such as high intake of plant-based foods, healthy fats, and limited consumption of red and processed meats. The Mediterranean and DASH diets, both emphasizing these elements, are repeatedly shown to lower stroke risk.
- Diets rich in fruits, vegetables, legumes, whole grains, nuts, and healthy fats (such as olive oil) are strongly associated with reduced risk of both stroke and cardiovascular disease 2 4 9 14.
- Limiting red and processed meats, refined grains, sweets, and saturated fats further contributes to the observed protective effect 4 9 14.
- The Mediterranean diet's benefits have been replicated in different populations, and similar results are seen with the DASH and healthy Nordic diets 1 2 6 10.
- These dietary patterns are also associated with reduced inflammatory markers and improved cardiovascular risk profiles 1 13 14.
How do dietary patterns compare to other lifestyle factors in stroke prevention?
Diet is one component of an overall healthy lifestyle, and its effects are amplified when combined with other low-risk behaviors. Research indicates that integrating diet, physical activity, smoking cessation, and weight management can have additive benefits for stroke prevention.
- Studies show that the combination of healthy lifestyle factors, including a nutritious diet, is associated with the greatest reductions in stroke risk 3 5 12 13.
- Estimates suggest that nearly half of stroke cases in women could be prevented by adhering to multiple low-risk behaviors 3 5.
- The American Heart Association and other expert groups recommend a holistic approach to cardiovascular health, emphasizing diet alongside other behaviors 12.
- The new study reinforces the importance of dietary modification as a key, but not solitary, preventive strategy 3 5 12 13.
Are there differences in the impact of diet on ischemic vs. hemorrhagic stroke?
While the majority of evidence indicates a stronger effect of healthy dietary patterns on ischemic stroke risk, emerging data—including from the present study—suggests that dietary benefits may also extend to hemorrhagic stroke, though further research is needed to clarify these effects.
- Most large cohort and systematic review studies report robust risk reduction for ischemic stroke, with less consistent findings for hemorrhagic stroke 5 6.
- The present study is notable for demonstrating a significant association between the Mediterranean diet and reduced risk of both ischemic and hemorrhagic stroke in women 2 4 8.
- Some evidence suggests that the protective dietary effect may be partially mediated by improvements in blood pressure and inflammation, which influence both stroke subtypes 1 13 14.
- The need for more focused research on hemorrhagic stroke is highlighted by both the new study and recent literature reviews 2 4 8.
Future Research Questions
Despite consistent associations between healthy dietary patterns and reduced stroke risk, important questions remain. Further research is needed to clarify causal pathways, determine the impact on different stroke subtypes, and identify effective dietary interventions across diverse populations.
| Research Question | Relevance |
|---|---|
| Does adherence to a Mediterranean diet causally reduce stroke risk in randomized controlled trials? | While observational studies show strong associations, randomized controlled trials are needed to establish causality and rule out confounding factors 2 8 10. |
| What are the mechanisms linking Mediterranean diet with reduced risk of ischemic and hemorrhagic stroke? | Understanding biological mechanisms (e.g., inflammation, blood pressure, lipid changes) can inform targeted prevention strategies and clarify why some stroke subtypes may be more affected 1 2 13 14. |
| Are the stroke protective effects of the Mediterranean diet consistent across different ethnic and age groups? | Most current research focuses on middle-aged or older women in high-income countries; assessing effects in more diverse populations is critical for generalizability 2 11 13. |
| How does self-reported dietary assessment accuracy influence observed diet-stroke risk associations? | Dietary data is often self-reported, which can introduce bias; improved assessment methods may help clarify true associations and strengthen evidence 2 4. |
| Can interventions to promote Mediterranean-style eating patterns reduce stroke incidence at the population level? | Translating individual-level findings to community or public health interventions could have broad impact, but requires evaluation of feasibility, effectiveness, and equity 8 12. |