Research Article| Volume 221, ISSUE 1, P282-286, March 2012

Dietary fats and dietary cholesterol and risk of stroke in women

  • Susanna C. Larsson
    Corresponding author at: Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden. Tel.: +46 8 52486059; fax: +46 8 304571.
    Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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  • Jarmo Virtamo
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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  • Alicja Wolk
    Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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      Whether intakes of dietary fat and cholesterol are associated with risk of stroke remain unclear. We examined the associations between intakes of total fat, specific types of fat, and cholesterol and risk of stroke in a prospective cohort of women.


      The study population consisted of 34,670 women, aged 49–83 years, in the Swedish Mammography Cohort who were free of cardiovascular disease and completed a food-frequency questionnaire in 1997. Cox proportional hazard regression models were used to estimate relative risks (RR) with 95% confidence intervals (CI).


      During a mean follow-up of 10.4 years, we ascertained 1680 stroke events, including 1310 cerebral infarctions, 233 hemorrhagic strokes, and 137 unspecified strokes. After adjustment for other stroke risk factors, intake of long-chain omega-3 polyunsaturated fatty acids (PUFA) was inversely associated with risk of total stroke. The multivariable RR of total stroke for the highest compared with the lowest quintile of long-chain omega-3 PUFA intake was 0.84 (95% CI, 0.72–0.99; P for trend = 0.04). Dietary cholesterol was positively associated with risk of total stroke (highest versus lowest quintile: RR = 1.20; 95% CI, 1.00–1.44; P for trend = 0.01) and cerebral infarction (corresponding RR = 1.29; 95% CI, 1.05–1.58; P for trend = 0.004). Total fat, saturated fat, monounsaturated fat, polyunsaturated fat, α-linolenic acid, and omega-6 PUFA intakes were not associated with stroke.


      These findings suggest that intake of long-chain omega-3 PUFAs is inversely associated with risk of stroke, whereas dietary cholesterol is positively associated with risk.


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        • Lichtenstein A.H.
        • Appel L.J.
        • Brands M.
        • et al.
        Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.
        Circulation. 2006; 114: 82-96
      1. World Health Organization (2003) Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Org Tech Rep 916(i–viii):1–149 (Geneva).

        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • et al.
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
        • 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
        • Gillman M.W.
        • Cupples L.A.
        • Millen B.E.
        • et al.
        Inverse association of dietary fat with development of ischemic stroke in men.
        JAMA. 1997; 278: 2145-2150
        • 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
        • Iso H.
        • Sato S.
        • Umemura U.
        • et al.
        Linoleic acid, other fatty acids, and the risk of stroke.
        Stroke. 2002; 33: 2086-2093
        • Iso H.
        • Sato S.
        • Kitamura A.
        • et al.
        Fat and protein intakes and risk of intraparenchymal hemorrhage among middle-aged Japanese.
        Am J Epidemiol. 2003; 157: 32-39
        • 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
        • 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
        • Leosdottir M.
        • Nilsson P.M.
        • Nilsson J.A.
        • Berglund G.
        Cardiovascular event risk in relation to dietary fat intake in middle-aged individuals: data from The Malmo Diet and Cancer Study.
        Eur J Cardiovasc Prev Rehabil. 2007; 14: 701-706
        • He K.
        • Rimm E.B.
        • Merchant A.
        • et al.
        Fish consumption and risk of stroke in men.
        JAMA. 2002; 288: 3130-3136
        • de Goede J.
        • Verschuren W.M.
        • Boer J.M.
        • et al.
        Alpha-linolenic acid intake and 10-year incidence of coronary heart disease and stroke in 20,000 middle-aged men and women in the Netherlands.
        PLoS One. 2011; 6: e17967
        • Geleijnse J.M.
        • Giltay E.J.
        • Grobbee D.E.
        • et al.
        Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials.
        J Hypertens. 2002; 20: 1493-1499
        • Gueyffier F.
        • Bulpitt C.
        • Boissel J.P.
        • et al.
        Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group.
        Lancet. 1999; 353: 793-796
        • Bejan-Angoulvant T.
        • Saadatian-Elahi M.
        • Wright J.M.
        • et al.
        Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials.
        J Hypertens. 2010; 28: 1366-1372
        • Staessen J.A.
        • Gasowski J.
        • Wang J.G.
        • et al.
        Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials.
        Lancet. 2000; 355: 865-872
        • Eslick G.D.
        • Howe P.R.
        • Smith C.
        • et al.
        Benefits of fish oil supplementation in hyperlipidemia: a systematic review and meta-analysis.
        Int J Cardiol. 2009; 136: 4-16
        • Knapp H.R.
        Dietary fatty acids in human thrombosis and hemostasis.
        Am J Clin Nutr. 1997; 65: 1687S-1698S
        • Andriamampandry M.D.
        • Leray C.
        • Freund M.
        • et al.
        Antithrombotic effects of (n-3) polyunsaturated fatty acids in rat models of arterial and venous thrombosis.
        Thromb Res. 1999; 93: 9-16
        • Calder P.C.
        Polyunsaturated fatty acids, inflammation, and immunity.
        Lipids. 2001; 36: 1007-1024
        • Iso H.
        • Rexrode K.M.
        • Stampfer M.J.
        • et al.
        Intake of fish and omega-3 fatty acids and risk of stroke in women.
        JAMA. 2001; 285: 304-312
        • Montonen J.
        • Järvinen R.
        • Reunanen A.
        • Knekt P.
        Fish consumption and the incidence of cerebrovascular disease.
        Br J Nutr. 2009; 102: 750-756
        • Morris M.C.
        • Manson J.E.
        • Rosner B.
        • et al.
        Fish consumption and cardiovascular disease in the physicians’ health study: a prospective study.
        Am J Epidemiol. 1995; 142: 166-175
        • Yuan J.M.
        • Ross R.K.
        • Gao Y.T.
        • Yu M.C.
        Fish and shellfish consumption in relation to death from myocardial infarction among men in Shanghai, China.
        Am J Epidemiol. 2001; 154: 809-816
        • Wolk A.
        • Bergström R.
        • Hunter D.
        • et al.
        A prospective study of association of monounsaturated fat and other types of fat with risk of breast cancer.
        Arch Intern Med. 1998; 158: 41-45
        • Bergström L.
        • Kylberg E.
        • Hagman U.
        • et al.
        The food composition database KOST: the National Administration's information system for nutritive values of food.
        Vår Föda. 1991; 43: 439-447
        • Willett W.
        • Stampfer M.J.
        Total energy intake: implications for epidemiologic analyses.
        Am J Epidemiol. 1986; 124: 17-27
        • Messerer M.
        • Johansson S.E.
        • Wolk A.
        The validity of questionnaire-based micronutrient intake estimates is increased by including dietary supplement use in Swedish men.
        J Nutr. 2004; 134: 1800-1805
        • Park Y.
        • Park S.
        • Yi H.
        • et al.
        Low level of n-3 polyunsaturated fatty acids in erythrocytes is a risk factor for both acute ischemic and hemorrhagic stroke in Koreans.
        Nutr Res. 2009; 29: 825-830
      2. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico.
        Lancet. 1999; 354: 447-455
        • Leppala J.M.
        • Virtamo J.
        • Fogelholm R.
        • et al.
        Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants.
        Stroke. 1999; 30: 2535-2540
        • Di Angelantonio E.
        • Sarwar N.
        • Perry P.
        • et al.
        Major lipids, apolipoproteins, and risk of vascular disease.
        JAMA. 2009; 302: 1993-2000
        • Ginsberg H.N.
        • Karmally W.
        • Siddiqui M.
        • et al.
        Increases in dietary cholesterol are associated with modest increases in both LDL and HDL cholesterol in healthy young women.
        Arterioscler Thromb Vasc Biol. 1995; 15: 169-178
        • Ginsberg H.N.
        • Karmally W.
        • Siddiqui M.
        • et al.
        A dose–response study of the effects of dietary cholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men.
        Arterioscler Thromb. 1994; 14: 576-586
        • Siri-Tarino P.W.
        • Sun Q.
        • Hu F.B.
        • Krauss R.M.
        Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.
        Am J Clin Nutr. 2010; 91: 535-546
        • Shiue I.
        • Arima H.
        • Hankey G.J.
        • Anderson C.S.
        Dietary intake of key nutrients and subarachnoid hemorrhage: a population-based case–control study in Australasia.
        Cerebrovasc Dis. 2011; 31: 464-470