| 1. |
- Hindy, George, et al.
(författare)
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Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes : A Mendelian Randomization Study
- 2018
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 49:4, s. 820-827
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Statin therapy is associated with a lower risk of ischemic stroke supporting a causal role of low-density lipoprotein (LDL) cholesterol. However, more evidence is needed to answer the question whether LDL cholesterol plays a causal role in ischemic stroke subtypes. In addition, it is unknown whether high-density lipoprotein cholesterol and triglycerides have a causal relationship to ischemic stroke and its subtypes. Our aim was to investigate the causal role of LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides in ischemic stroke and its subtypes through Mendelian randomization (MR).METHODS: Summary data on 185 genome-wide lipids-associated single nucleotide polymorphisms were obtained from the Global Lipids Genetics Consortium and the Stroke Genetics Network for their association with ischemic stroke (n=16 851 cases and 32 473 controls) and its subtypes, including large artery atherosclerosis (n=2410), small artery occlusion (n=3186), and cardioembolic (n=3427) stroke. Inverse-variance-weighted MR was used to obtain the causal estimates. Inverse-variance-weighted multivariable MR, MR-Egger, and sensitivity exclusion of pleiotropic single nucleotide polymorphisms after Steiger filtering and MR-Pleiotropy Residual Sum and Outlier test were used to adjust for pleiotropic bias.RESULTS: A 1-SD genetically elevated LDL cholesterol was associated with an increased risk of ischemic stroke (odds ratio: 1.12; 95% confidence interval: 1.04-1.20) and large artery atherosclerosis stroke (odds ratio: 1.28; 95% confidence interval: 1.10-1.49) but not with small artery occlusion or cardioembolic stroke in multivariable MR. A 1-SD genetically elevated high-density lipoprotein cholesterol was associated with a decreased risk of small artery occlusion stroke (odds ratio: 0.79; 95% confidence interval: 0.67-0.90) in multivariable MR. MR-Egger indicated no pleiotropic bias, and results did not markedly change after sensitivity exclusion of pleiotropic single nucleotide polymorphisms. Genetically elevated triglycerides did not associate with ischemic stroke or its subtypes.CONCLUSIONS: LDL cholesterol lowering is likely to prevent large artery atherosclerosis but may not prevent small artery occlusion nor cardioembolic strokes. High-density lipoprotein cholesterol elevation may lead to benefits in small artery disease prevention. Finally, triglyceride lowering may not yield benefits in ischemic stroke and its subtypes.
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| 2. |
- Kaluza, Joanna, et al.
(författare)
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Heme Iron Intake and Risk of Stroke A Prospective Study of Men
- 2013
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 44:2, s. 334-
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-Intake of iron, especially heme iron, has been associated with several diseases. However, epidemiological studies of heme iron and nonheme iron intake in relation to risk of stroke are lacking. The aim of this study was to examine the associations between heme iron and nonheme iron intake and stroke incidence in men. Methods-The population-based prospective Cohort of Swedish Men included 38 859 men, aged 45 to 79 years, who had no history of stroke, coronary heart disease, or cancer at baseline. Hazard ratios and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards regression models. Results-During an 11.7 years follow-up, 3097 incident cases of stroke, including 2482 cerebral infarctions and 450 intracerebral hemorrhages, were registered. The hazard ratios of total stroke and cerebral infarction for the highest compared with the lowest quintiles of heme iron intake were 1.16 (95% CI, 1.03-1.31; P trend=0.037) and 1.15 (95% CI, 1.00-1.31; P trend=0.089), respectively. The incidence rates of total stroke per 10 000 person-years were 72.6 in the lowest quintile and 84.4 in the highest. The association was confined to men with body mass index <25 kg/m(2), the hazard ratios were 1.40 (95% CI, 1.17-1.68; P trend<0.001) for total stroke and 1.38 (95% CI, 1.13-1.70; P trend=0.001) for cerebral infarction; no association was observed among overweight and obese men. There was no association between nonheme iron intake and risk of total stroke and stroke types. Conclusions-Findings from this prospective study indicate that a high heme iron intake, particularly in normal weight individuals, may increase the risk of stroke. (Stroke. 2013; 44: 334-339.)
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| 3. |
- Kaluza, Joanna, et al.
(författare)
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Red Meat Consumption and Risk of Stroke A Meta-Analysis of Prospective Studies
- 2012
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 43:10, s. 2556-
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-Prospective studies of red meat consumption and risk of stroke have provided inconsistent results. We performed a meta-analysis to summarize the evidence regarding the effects of red meat (fresh, processed, and total) consumption on stroke risk. Methods-Studies were identified by searching the PubMed database through May 26, 2012, and by reviewing the reference lists of retrieved articles. Prospective studies that reported relative risks (RR) with 95% confidence intervals (CI) for the association between red meat consumption and risk of stroke were eligible. Results were combined using a random-effects model. Results-Five articles including results from 6 prospective studies with 10 630 cases of stroke and 329 495 participants were included in the meta-analysis. For each serving per day increase in fresh red meat, processed meat, and total red meat consumption, the RR (95% CI) of total stroke were 1.11 (1.03-1.20), 1.13 (1.03-1.24), and 1.11 (1.06-1.16), respectively, without heterogeneity among studies (P>0.16). Among 4 articles with results for stroke subtypes, the risk of ischemic stroke was positively associated with consumption of fresh red meat (RR, 1.13; 95% CI, 1.00-1.27), processed meat (RR, 1.15; 95% CI, 1.06-1.24), and total red meat (RR, 1.12; 95% CI, 1.05-1.19); no statistically significant associations were observed for hemorrhagic stroke. Conclusion-Results from this meta-analysis indicate that consumption of fresh red meat and processed red meat as well as total red meat is associated with increased risk of total stroke and ischemic stroke, but not hemorrhagic stroke. (Stroke. 2012; 43: 2556-2560.)
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| 4. |
- Larsson, Susanna C., et al.
(författare)
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Coffee Consumption and Risk of Stroke in Women
- 2011
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 42:4, s. 908-912
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-Coffee consumption has been inconsistently associated with stroke incidence and mortality in previous studies. We investigated the association between coffee consumption and stroke incidence in the Swedish Mammography Cohort. Methods-We prospectively followed of 34 670 women without a history of cardiovascular disease or cancer at baseline in 1997. Coffee consumption was assessed in 1997 using a self-administered questionnaire. Incident stroke cases were ascertained from the Swedish Hospital Discharge Registry. Results-During a mean follow-up of 10.4 years, we ascertained 1680 stroke events, including 1310 cerebral infarctions, 154 intracerebral hemorrhages, 79 subarachnoid hemorrhages, and 137 unspecified strokes. After adjustment for other risk factors, coffee consumption was associated with a statistically significant lower risk of total stroke, cerebral infarction, and subarachnoid hemorrhage but not intracerebral hemorrhage. The multivariable relative risks of total stroke across categories of coffee consumption (< 1 cup/ day, 1 to 2 cups/day, 3 to 4 cups/day, and >= 5 cups/day) were 1.00, 0.78 (95% CI, 0.66 to 0.91), 0.75 (95% CI, 0.64 to 0.88), and 0.77 (95% CI, 0.63 to 0.92, respectively; P for trend=0.02). The association between coffee consumption and cerebral infarction was not modified by smoking status, body mass index, history of diabetes or hypertension, or alcohol consumption. Conclusions-These findings suggest that low or no coffee consumption is associated with an increased risk of stroke in women. (Stroke. 2011;42:908-912.)
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| 5. |
- Larsson, Susanna C., et al.
(författare)
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Dairy Consumption and Risk of Stroke in Swedish Women and Men
- 2012
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 43:7, s. 1775-1780
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-Epidemiological studies of the associations of low-fat dairy and specific dairy food consumption with risk of stroke are sparse. Our aim was to examine the association between consumption of total, low-fat, full-fat, and specific dairy foods and risk of stroke in a prospective cohort study. Methods-We followed 74 961 Swedish women and men who were free from cardiovascular disease and cancer and who completed a 96-item food frequency questionnaire in 1997. Incident cases of stroke were ascertained from the Swedish Hospital Discharge Registry. Results-During a mean follow-up of 10.2 years, we ascertained 4089 cases of stroke, including 3159 cerebral infarctions, 583 hemorrhagic strokes, and 347 unspecified strokes. Consumption of low-fat dairy foods was inversely associated with risk of total stroke (P for trend=0.03) and cerebral infarction (P for trend=0.03). The multivariable relative risks for the highest compared with the lowest quintile of low-fat dairy consumption were 0.88 (95% CI, 0.80-0.97) for total stroke and 0.87 (95% CI, 0.78-0.98) for cerebral infarction. Consumption of total dairy, full-fat dairy, milk, sour milk/yogurt, cheese, and cream/creme fraiche was not associated with stroke risk. Conclusions-These results suggest that low-fat dairy consumption is inversely associated with the risk of stroke. (Stroke. 2012;43:1775-1780.)
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| 6. |
- Larsson, Susanna C.
(författare)
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Dietary Approaches for Stroke Prevention
- 2017
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 48:10, s. 2905-2911
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Tidskriftsartikel (refereegranskat)abstract
- Stroke is a leading cause of mortality and long-term disability. The consequences of stroke are often devastating and irreversible. Many stroke survivors experience mental and physical impairment and require assistance with daily life activities. Prevention of stroke through modifiable risk factors, such as diet, is, therefore, crucial to public health. Diet may influence stroke development through multiple pathways and mechanisms, including effects on blood pressure, blood lipids, thrombosis and coagulation, oxidative stress, systemic inflammation, endothelial function, glucose and insulin homeostasis, gut microbiome, and body weight. This review summarizes available data from prospective studies and randomized controlled trials (RCTs) of the associations of dietary patterns, foods, beverages, selected nutrients, and bioactive compounds with stroke risk.
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| 7. |
- Larsson, Susanna C., et al.
(författare)
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Dietary Approaches to Stop Hypertension Diet and Incidence of Stroke : Results From 2 Prospective Cohorts
- 2016
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 47:4, s. 986-990
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: High adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower risk of hypertension, the major risk factor for stroke. We examined whether adherence to the DASH diet is inversely associated with the incidence of stroke.METHODS: The study population comprised 74 404 men and women (45-83 years of age), without stroke at baseline, from the Cohort of Swedish Men and the Swedish Mammography Cohort. Diet was assessed with a food-frequency questionnaire. A modified DASH diet score was created based on consumption of vegetables, fruits, legumes and nuts, whole grains, low-fat dairy, red meat and processed meat, and sweetened beverages. Stroke cases were identified through linkage to the Swedish National Patient and Cause of Death Registers. Relative risks and 95% confidence intervals were estimated using Cox proportional hazards regression model.RESULTS: During 882 727 person-years (mean, 11.9 years) of follow-up, 3896 ischemic strokes, 560 intracerebral hemorrhages, and 176 subarachnoid hemorrhages were ascertained. The modified DASH diet score was statistically significantly inversely associated with the risk of ischemic stroke (P for trend=0.002), with a multivariable relative risk of 0.86 (95% confidence interval, 0.78-0.94) for the highest versus the lowest quartile of the score. The modified DASH diet score was nonsignificantly inversely associated with intracerebral hemorrhage (corresponding relative risk=0.81; 95% confidence interval, 0.63-1.05) but was not associated with subarachnoid hemorrhage.CONCLUSIONS: These findings indicate that high adherence to the DASH diet is associated with a reduced risk of ischemic stroke.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01127698 and NCT01127711 for the Swedish Mammography Cohort and the Cohort of Swedish Men, respectively.
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| 8. |
- Larsson, Susanna C., et al.
(författare)
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Dietary cysteine and other amino acids and stroke incidence in women
- 2015
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 46:4, s. 922-926
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Cysteine could potentially lower the risk of stroke through antihypertensive and antioxidant effects. Our aim was to evaluate the hypothesis that cysteine intake is inversely associated with stroke incidence.METHODS: We used data from the Swedish Mammography Cohort, a population-based prospective cohort of 34 250 women who were free of cardiovascular disease and cancer and had completed a food-frequency questionnaire about diet and other risk factors for stroke in the autumn of 1997. Stroke cases were identified by linkage of the study population with the Swedish Inpatient Register and the Swedish Cause of Death Register. Relative risks (RR) with 95% confidence intervals, adjusted for potential confounders, were estimated by using Cox proportional hazards regression model.RESULTS: We ascertained 1751 incident cases of stroke during 10.4 years of follow-up. Dietary cysteine intake (mean, 635 mg/d) was inversely associated with stroke risk. The multivariable RR of total stroke comparing the highest with the lowest quintile of cysteine intake was 0.79 (95% confidence interval, 0.65-0.97; P for trend=0.04). The corresponding RR was 0.82 (95% confidence interval, 0.65-1.03; P for trend=0.12) for cerebral infarction and 0.54 (95% confidence interval, 0.29-1.03; P for trend=0.08) for intracerebral hemorrhage. Dietary intake of other amino acids showed no independent (after adjustment for cysteine intake) association with stroke risk.CONCLUSIONS: These findings suggest that dietary cysteine intake may be inversely associated with risk of stroke.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01127698.
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| 9. |
- Larsson, Susanna C., et al.
(författare)
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Dietary Potassium Intake and Risk of Stroke A Dose-Response Meta-Analysis of Prospective Studies
- 2011
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 42:10, s. 2746-2750
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-Potassium intake has been inconsistently associated with risk of stroke. Our aim was to conduct a meta-analysis of prospective studies to assess the relation between potassium intake and stroke risk. Methods-Pertinent studies were identified by a search of PubMed from January 1966 through March 2011 and by reviewing the reference lists of retrieved articles. We included prospective studies that reported relative risks with 95% CIs of stroke for >= 3 categories of potassium intake or for potassium intake analyzed as a continuous variable. Study-specific results were pooled using a random-effects model. Results-Ten independent prospective studies, with a total of 8695 stroke cases and 268 276 participants, were included in the meta-analysis. We observed a statistically significant inverse association between potassium intake and risk of stroke. For every 1000-mg/day increase in potassium intake, the risk of stroke decreased by 11% (pooled relative risk, 0.89; 95% CI, 0.83 to 0.97). In the 5 studies that reported results for stroke subtypes, the pooled relative risks were 0.89 (95% CI, 0.81 to 0.97) for ischemic stroke, 0.95 (95% CI, 0.83 to 1.09) for intracerebral hemorrhage, and 1.08 (95% CI, 0.92 to 1.27) for subarachnoid hemorrhage. Conclusions-Dietary potassium intake is inversely associated with risk of stroke, in particular ischemic stroke. (Stroke. 2011; 42: 2746-2750.)
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| 10. |
- Larsson, Susanna C., et al.
(författare)
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Red Meat Consumption and Risk of Stroke in Swedish Women
- 2011
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Ingår i: Stroke. - : LIPPINCOTT WILLIAMS & WILKINS. - 0039-2499 .- 1524-4628. ; 42:2, s. 324-329
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose-High red meat consumption has been associated with increased risk of some cancers and may also be a risk factor for cardiovascular diseases. However, epidemiological studies of red meat consumption in relation to risk of stroke are very limited. Our objective was to examine the association between red meat consumption and stroke incidence in the Swedish Mammography Cohort. Methods-We prospectively followed 34 670 women without cardiovascular disease and cancer at baseline. Participants completed a self-administered questionnaire on diet and other risk factors for cardiovascular diseases in 1997. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RR) and 95% CI. Results-During a mean follow-up of 10.4 years, we ascertained 1680 incident cases of stroke, comprising 1310 cerebral infarction, 154 intracerebral hemorrhage, 79 subarachnoid hemorrhage, and 137 unspecified stroke. Total red meat and processed meat consumption was associated with a statistically significant increased risk of cerebral infarction, but not of total stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. The multivariable RR of cerebral infarction for the highest versus the lowest quintile of consumption were 1.22 (95% CI, 1.01-1.46) for red meat and 1.24 (95% CI, 1.04-1.49) for processed meat. Fresh (unprocessed) meat consumption was not associated with total stroke or with any stroke subtype. Conclusion-Findings from this study suggest that red and processed meat consumption may increase the risk of cerebral infarction in women. (Stroke. 2011;42:324-329.)
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