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Diet Rich in Antioxidants May Cut Stroke Risk

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December 2, 2011 — Women who eat an antioxidant-rich diet may significantly cut

their stroke risk, particularly those without a history of cardiovascular

disease (CVD), new research suggests.

The prospective study found that women with no history of CVD who consumed the

highest amount of antioxidants in foods such as fruit, vegetables, tea, whole

grains, and chocolate had a 17% lower risk for strokes than those who ate the

least amount. Among women with a history of CVD, those who consumed the most

antioxidants had a 45% lower risk for hemorrhagic strokes.

" This study suggests that eating a diet rich in antioxidants, especially from

fruits and vegetables, may be of importance for stroke prevention, " lead author

ne Rautiainen, MSc, a PhD student at Karolinska Institutet, Sweden, told

Medscape Medical News.

The study was published online December 1 in Stroke: Journal of the American

Heart Association.

Antioxidant Capacity

Researchers used the Swedish Mammography Cohort, a database that includes women

born from 1914 to 1948 in the counties of Uppsala and Västmanland, Sweden. The

cohort contained 36,715 women who were followed up from September 15, 1997, to

December 31, 2009. A 1997 questionnaire on diet, education, weight, height, and

potential risk factors for stroke served as a baseline for the analysis.

Investigators calculated the total antioxidant capacity (TAC) in the diet, using

a database of the most common foods. " The TAC does not identify specific

antioxidants, but rather, it measures the entire antioxidant network, including

all present antioxidants, and takes into account the synergistic effects between

compounds, " explained Ms. Rautiainen.

The researchers analyzed the 31,035 women who were free of CVD at baseline

separately from the 5680 women with a history of CVD. Members of the CVD-free

cohort were categorized into quintiles, and those with a CVD history into

quartiles, of dietary TAC.

From the Swedish Hospital Discharge Registry, researchers identified 1322

strokes among CVD-free women and 1007 strokes among those with a history of CVD.

Risk was adjusted for age, education, smoking body mass index, physical

activity, hypertension, hypercholesterolemia, diabetes, family history of

myocardial infarction, aspirin use, dietary supplement use, and intakes of total

energy, alcohol, and coffee.

The researchers report that among the CVD-free women, those in the highest

quintile of dietary TAC had a statistically significant 17% lower risk for total

stroke compared with women in the lowest quintile (hazard ratio, 0.83; 95%

confidence interval, 0.70 - 0.99; P = .04).

Dietary TAC was inversely associated with both cerebral infarction and

hemorrhagic stroke, although these results were not statistically significant.

Fruits and vegetables contributed about 50% of TAC. Other contributors included

whole grains (18%), tea (16%), and chocolate (5%).

CVD Subgroup

In the CVD subgroup, women in the highest quartile of dietary TAC had a

significant 45% lower risk for hemorrhagic stroke compared with those in the

lowest quartile (adjusted hazard ratio, 0.55; 95% confidence interval, 0.32 -

0.95; P = .03). However, there was no association with total stroke.

In this subgroup, women in the lowest TAC quartile might have been more likely

to have a history of stroke, and therefore be more likely to get a hemorrhagic

stroke, although the inverse association remained after adjusting for history of

stroke, said Ms. Rautiainen.

" Women with a CVD history may control their blood pressure or change their

lifestyles because of knowledge of their disease, " she speculated. " This might

have produced a spurious inverse association between TAC of diet and risk of

hemorrhagic stroke. "

The findings of this study seem to conflict with those of previous research that

failed to show beneficial effects of antioxidant supplements on stroke risk.

" The contradiction may be explained by the fact [that] these studies looked at

high doses of single antioxidants, whereas we aimed to examine antioxidant

intake by taking into account all antioxidants present in the diet, including

thousands of compounds, in doses obtained from a usual diet, " said Ms.

Rautiainen.

Oxidative stress may be at the root of some strokes, as the body may be unable

to neutralize cell-damaging free radicals, which can lead to inflammation and

vascular damage, said Ms. Rautiainen.

How might antioxidant-rich foods reduce this stroke risk? According to Ms.

Rautiainen, vitamins C and E, carotenoids, flavonoids, and other such compounds

scavenge free radicals, thereby inhibiting oxidative stress. " Antioxidants,

especially flavonoids, may also help improve endothelial function and reduce

blood clotting, blood pressure, and inflammation, " she said.

The next step for the research team is to see whether TAC intake is associated

with CVDs other than stroke, she concluded.

Overall Strengths

Approached for comment, Louise D. McCullough, MD, PhD, from the Department of

Neurology and the Department of Neuroscience, University of Connecticut Health

Center, and the Stroke Center at Hartford Hospital, said the study's overall

strengths were its size and the fact that the cohort was followed up for such a

long time.

" This is by far the biggest and most complete trial that's been done, " she said.

The results confirm what has been long suspected: " People have known from

retrospective trials and correlative studies that antioxidants in fruits and

vegetables, etc, reduce stroke risk, " said Dr. McCullough. " This confirms it in

a prospective trial. "

She pointed out that eating a healthy, antioxidant-rich diet is associated other

healthy behaviors. " People who tend to eat healthier tend to also have healthier

lifestyles as a whole, but even controlling for that, in this large population

it does seem that the diet had an independent beneficial effect on stroke

incidence. "

Dr. McCullough noted that the reduced risk among health women " wasn't a huge

change in risk " in terms of absolute numbers, but she emphasized that reducing

stroke risk by incorporating more antioxidant-rich foods in the diet is

relatively easy to do.

The study was supported by the Swedish Research Council for Infrastructure and

the Swedish Council for Working Life and Social Research. The authors have

disclosed no relevant financial relationships.

Stroke. Published online December 1, 2011. Full text