Skip to content

A big study that found that eating a greater proportion of plant-based foods (fruits, vegetables, grains, beans, potatoes, nuts, olive oil), as compared to animal-based foods, is linked to lower risks of dying from heart disease and stroke.

From Science Daily: Semi-veggie diet effectively lowers heart disease, stroke risk.

A pro-vegetarian diet -- one that has a higher proportion of plant-based foods compared to animal-based foods is linked to lower risks of dying from heart disease and stroke, according to new research presented at the American Heart Association EPI/Lifestyle 2015 meeting. In an observational study, researchers analyzed the eating and lifestyle habits of 451,256 Europeans.

People who ate the most pro-vegetarian style diets (up to 70 percent of food coming from plant sources) had a 20 percent lower risk of dying from cardiovascular disease, compared to those who were the least pro-vegetarian (<45 percent). "A pro-vegetarian diet doesn't make absolute recommendations about specific nutrients. It focuses on increasing the proportion of plant based foods relative to animal-based foods, which results in an improved nutritionally balance diet," said Camille Lassale, Ph.D., lead author and an epidemiologist at Imperial College London's School of Public Health.

Participants were part of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, started in 1992. The study included nearly half a million people from 10 countries who were free of chronic diseases at the start of the study, 35 to 70 years and followed for 12 years on average....Researchers scored participants based on the types of foods they ate. Points were given for eating foods from seven plant food groups: vegetables, fruit, beans, cereals, potatoes, nuts, and olive oil. Points were subtracted for five animal food groups: meats, animal fats, eggs, fish, and other seafood or dairy products. Based on their scores, participants were categorized from the least pro-vegetarian to the most. 

Researchers analyzed the relationship between eating habits and death risks from heart disease and stroke."Instead of drastic avoidance of animal-based foods, substituting some of the meat in your diet with plant-based sources may be a very simple, useful way to lower cardiovascular mortality," said Lassale. These findings are in line with the wealth of evidence on benefits of eating plant foods to prevent CVD.

The American Heart Association recommends following a heart-healthy diet, which could also be described as a pro-vegetarian diet. It is high in fruits, vegetables, whole grains, legumes, beans, and nuts, low-fat dairy, beans, skinless poultry, and fish. It encourages eating foods low in saturated and trans fats and sodium, and limiting added sugars and red meats.

This article raises serious questions about the recently published American College of Cardiology and American Heart Association calculators to predict future cardiovascular events (heart attack, strike, etc) which then give recommendations for who needs to take daily statins while they are still healthy. This calculator (ACC/AHA risk calculator) has sparked much debate because many experts believe it overestimates risk. Now a study that looked at untreated people (MESA) showed that the calculator (as well as 3 other calculators) seriously overpredict the chance of a future cardiovascular event. In other words, many, many healthy people told they "may" have a chance of an event in the future are actually not at risk and so statins would not help them, but may harm them. Remember, all medicines have side-effects. Written by cardiac electrophysiologist Dr. John Mandrola (who has his own blog-site www,drjohnm.org) . From Medscape:

Statins in Primary Prevention: Welcome to the Gray Zone

A new study published in the Annals of Internal Medicine confirmed something that ought to be obvious: predicting the future is hard—especially when it comes to cardiovascular events.

We know cardiovascular disease is the number-one killer of humans; we know its first manifestation is often heart attack, stroke, or death; and we know all medical therapy comes with trade-offs. Medical treatment of healthy people in the name of preventing something that may or may not happen in the future is dicey. Think do no harm. That is where risk prediction comes in. You have to know the odds of something (or nothing) happening without treatment. The gamble of statins and aspirin, for instance, looks most favorable in patients who are most likely to have an event.

 But where to draw that line, at what future risk is it worth taking a chemical, is the issue at hand. The extreme cases are easy. Most everyone agrees that statins and aspirin provide enough benefit in patients who have suffered a cardiovascular event. For secondary prevention, future risk is high, so benefits outweigh harms. It's the opposite in very low-risk patients. The middle ground is not so easy.

Here is where we have to consider the tools—calculators—to predict future risk. We know certain conditions, such as age, gender, blood pressure, diabetes, smoking, biomarkers, family history, and coronary calcium, contribute to future risk. Numerous expert panels, including the American College of Cardiology and American Heart Association, have compiled different calculators to predict the future. The ACC/AHA risk calculator for atherosclerotic CVD (ASCVD) has sparked debate because many experts believe it overestimates risk.

Dr Andrew DeFillippis (University of Louisville, KY) and a team of Multi-Ethnic Study of Atherosclerosis (MESA) coinvestigators used this community-based, sex-balanced, multiethnic cohort to compare the calibration and discrimination of the new ASCVD risk score with alternative risk scores.They compared the observed and expected events for the ASCVD score with three Framingham-based scores and the Reynolds risk score in 4227 MESA subjects aged 50 to 74 years over a 10-year follow-up. Using this real-world population, they found four of the five risk scores overestimated risk. Calibration was worse in men: overestimates ranged from 37% to 154%. In women, three of four scores overestimated risk by 46% to 67%, and the Reynolds Risk score underestimated risk by 21%. 

It's worth saying this another way: when the ACC/AHA ASCVD score predicted event rates of 7.5 to 10%—a range deemed above the statin-benefit cutoff—the actual events were just 3%.

Speaking by phone (we live in the same city), lead author Dr DeFillippis explained to me the important business of looking only at untreated patients. He described their sensitivity analysis, which excluded all patients who received aspirin or any lipid-lowering or antihypertensive drug. To lessen the chance of bias, they analyzed this drug-free group of 790 patients separately and found the same overprediction.The authors concluded that if these findings are validated, overestimation of ASCVD risk may have substantial implications for individual patients and the healthcare system.

On that modern theme, Dr DeFillippis made an interesting point to me about the overall best-performing Reynolds Risk score. He noted the Reynolds score uses genetics (family history) and CRP (inflammation) levels to predict the future. Bookmark that for the future—genetics and inflammation, that is.

These findings have major implications. Drugs are not free. Aspirin and statins come with side effects and dollar costs. The patient who takes these drugs in hopes of preventing future events makes the gamble that the costs are worth the benefit. Policy makers who recommend these drugs expose millions of people to a therapy that turns on delicate balance between future benefit and harm.

The final point to make is that the use of statins and other drugs for the prevention of future events is not a doctor's or professional society's decision. The human being who swallows a drug must ultimately decide whether the gamble is favorable.

Some weekly strenuous activity is best for women's health. From Science Daily:

Women active a few times weekly have lower risk of heart disease, stroke and blood clots

Middle-aged women physically active a few times per week have lower risks of heart disease, stroke and blood clots than inactive women. More frequent physical activity does not appear to lower the risks further, research shows.

In the study: - Women who performed strenuous physical activity -- enough to cause sweating or a faster heart beat -- two to three times per week were about 20 percent less likely to develop heart disease, strokes or blood clots compared to participants who reported little or no activity. - Among active women, there was little evidence of further risk reductions with more frequent activity. - Physical activities associated with reduced risk included walking, gardening, and cycling.

Participants included 1.1 million women in the United Kingdom with no history of cancer, heart disease, stroke, blood clots, or diabetes who joined the Million Women study in 1996-2001. Their average age when they joined the study was 56. The women reported their level of physical activity at the beginning of the study and three years later. Researchers then examined hospital admissions and deaths in relation to participants' responses. Follow-up was, on average, nine years.

Another study that links following the Mediterranean diet with a beneficial health effect - this time a lower risk of ischemic stroke. Unfortunately, it did not seem to lower the risk of hemorrhagic stroke.

The findings were presented at the American Stroke Association's annual meeting. From Medical Xpress:

Mediterranean diet may lower stroke risk, study finds

A Mediterranean diet may reduce your risk of one type of stroke, new research suggests. People who most closely followed the Mediterranean diet were less likely to suffer an ischemic stroke—caused by a blood clot—compared to people with the lowest adherence to the diet, the study found.

A Mediterranean diet includes plenty of fruits and vegetables, whole grains, legumes, nuts, fish, poultry and olive oil. There is limited consumption of red meat, sweets and saturated fats such as those in meat, butter and full-fat dairy products, according to the researchers.

Sherzai's team analyzed data from more than 104,000 teachers in California, averaging 52 years of age, who are taking part in a long-term study. The participants, 90 percent of who were white, were divided into five groups based on how well they followed a Mediterranean diet.

While closely following a Mediterranean diet was associated with a reduced risk of a stroke caused by a blood clot, the healthy eating plan had no effect on a person's odds for a bleeding (hemorrhagic) stroke, according to the study.

According to the researchers, prior research has shown that people who follow a Mediterranean diet have a lower risk of heart disease, mental decline and death, but there is little information about how the diet affects stroke risk.Wright noted that the study was especially rigorous, since the authors accounted for "other factors that would reduce stroke risks, such as exercise, total caloric intake,body mass index, smoking and menopausal/hormonal status."

The possibility of lowering the risk of ischemic stroke (and poor recovery from it) is a good reason to try to increase vitamin D levels - by supplements and/or sunlight. Note that an ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. From Medical Xpress:

Low vitamin D predicts more severe strokes, poor health post-stroke

Stroke patients with low vitamin D levels were found to be more likely than those with normal vitamin D levels to suffer severe strokes and have poor health months after stroke, according to research presented at the American Stroke Association's International Stroke Conference 2015. Low vitamin D has been associated in past studies with neurovascular injury (damage to the major blood vessels supplying the brain, brainstem, and upper spinal cord).

"Many of the people we consider at high risk for developing stroke have low vitamin D levels. Understanding the link between stroke severity and vitamin D status will help us determine if we should treat vitamin D deficiency in these high-risk patients," said Nils Henninger, M.D., senior study author and assistant professor of neurology and psychiatry at University of Massachusetts Medical School in Worchester.

Henninger and colleagues studied whether low blood levels of 25-hydroxyvitamin D, a marker of vitamin D status, is predictive of ischemic stroke severity and poor health after stroke in 96 stroke patients treated between January 2013 and January 2014 at a U.S. hospital. They found:

  • Overall, patients who had low vitamin D levels –defined as less than 30 nanograms per milliliter (ng/mL) – had about two-times larger areas of dead tissue resulting from obstruction of the blood supply compared to patients with normal vitamin D levels.
  • This association was similar among patients who suffered lacunar strokes (in which the small, intricate arteries of the brain are affected) and patients with non-lacunar strokes (such as those caused by carotid disease or by a clot that originated elsewhere in the body).
  • For each 10 ng/mL reduction in vitamin D level, the chance for healthy recovery in the three months following stroke decreased by almost half, regardless of the patient's age or initial stroke severity.

It's interesting how drinking alcohol seems to have a J-curve for health effects. Light drinkers seem to do the best, but heavy drinkers do the worst of all groups (also see earlier posts). This research (published this week in the journal Stroke) shows that drinking more than 2 drinks a day in middle age is a bigger risk factor (double the risk) for a stroke between the ages of 60 to 75 years than high blood pressure, diabetes, or genetics. And once again, looking at the study one can see that nondrinkers had a small increased risk for stroke vs very light drinkers. From Science Daily:

Heavy drinking in middle-age may increase stroke risk more than traditional factors

Drinking more than two alcoholic beverages a day in middle-age raised stroke risks more than traditional factors such as high blood pressure and diabetes. Heavy drinking in mid-life was linked to having a stroke about five years earlier in life irrespective of genetic and early-life factors.

In a study of 11,644 middle-aged Swedish twins who were followed for 43 years, researchers compared the effects of an average of more than two drinks daily ("heavy drinking") to less than half a drink daily ("light drinking").

The study showed that: - Heavy drinkers had about a 34 percent higher risk of stroke compared to light drinkers. - Mid-life heavy drinkers (in their 50s and 60s) were likely to have a stroke five years earlier in life irrespective of genetic and early-life factors. - Heavy drinkers had increased stroke risk in their mid-life compared to well-known risk factors like high blood pressure and diabetes.At around age 75, blood pressure and diabetes appeared to take over as one of the main influences on having a stroke.

Researchers analyzed results from the Swedish Twin Registry of same-sex twins who answered questionnaires in 1967-70. All twins were under age 60 at the start. By 2010, the registry yielded 43 years of follow-up, including hospital discharge and cause of death data. ... Almost 30 percent of participants had a stroke. They were categorized as light, moderate, heavy or non-drinkers based on the questionnaires. 

Among identical twin pairs, siblings who had a stroke drank more than their siblings who hadn't had a stroke, suggesting that mid-life drinking raises stroke risks regardless of genetics and early lifestyle.

The study is consistent with the American Heart Association's recommended limit of two drinks a day for men and one for women. That's about 8 ounces of wine (two drinks) for a man and 4 ounces (one drink) for a woman. Regular heavy drinking of any kind of alcohol can raise blood pressure and cause heart failure or irregular heartbeats over time with repeated drinking, in addition to stroke and other risks.

There have been a number of recent studies finding various harms from air pollution - both for children and adults.The following are all from Science Daily:

Living near major roads may increase risk of sudden cardiac death in women

Living near a major road was associated with an increased risk of sudden cardiac death in women. Environmental exposure may increase heart disease risk as much as smoking, poor diet or obesity.

In 523 cases of sudden cardiac death, living within 50 meters (164 feet) of a major road increased the risk of sudden cardiac death by 38 percent, compared to living at least 500 meters (.3 miles) away. Each 100 meters (328 feet) closer to roadways was associated with a 6 percent increased risk for sudden cardiac death.

Air pollution harmful to young brains, study finds

Pollution in many cities threatens the brain development in children. Findings from a recent study reveal that children living in megacities are at increased risk for brain inflammation and neurodegenerative changes, including Alzheimer's or Parkinson's disease.

The study found when air particulate matter and their components such as metals are inhaled or swallowed, they pass through damaged barriers, including respiratory, gastrointestinal and the blood-brain barriers and can result in long-lasting harmful effects..."We asked why a clinically healthy kid is making autoantibodies against their own brain components," Calderón-Garcidueñas said. "That is indicative of damage to barriers that keep antigens and neurotoxins away from the brain. Brain autoantibodies are one of the features in the brains of people who have neuroinflammatory diseases like multiple sclerosis."

High-pollution days linked to increased risk of cardiac arrest

Rates of out-of-hospital cardiac arrest are elevated after days with high levels of air pollutants, reports a Japanese study. For example, 48 to 72 hours after days with high levels of particulate air pollution, the risk of out-of-hospital cardiac arrest increased by 17 percent, the researchers report.

Strong link between higher levels of pollution, lung health of European citizens

New data has identified a clear link between higher levels of exposure to air pollution and deteriorating lung health in adult European citizens. This study confirms previous findings that children growing up in areas with higher levels of pollution will have lower levels of lung function and a higher risk of developing symptoms such as cough and bronchitis symptoms. The new study also identified that people suffering from obesity are particularly vulnerable to the negative effects of air pollution, possibly due to an increased risk of lung inflammation.

Air pollution linked to irregular heartbeat, lung blood clots

Air pollution is linked to an increased risk of developing an irregular heartbeat -- a risk factor for stroke -- and blood clots in the lung, finds a large study. The evidence suggests that high levels of certain air pollutants are associated with a higher risk of cardiovascular problems, but exactly how this association works has not been clarified.

According to a recent large Swedish study, a healthy lifestyle lowers the risk of ischemic stroke (caused by a blood clot) - up to 54% lower risk. But unfortunately it does not lower the risk for a hemorrhagic stroke.

A healthy lifestyle was considered to be: healthy diet, moderate alcohol consumption, not smoking, being physically active, and being a normal weight (not overweight or obese). The more healthy life-style factors, the lower the risk for an ischemic stroke. In this study, healthy foods were considered to be: fruits, vegetables, legumes (beans), nuts, low-fat dairy foods, whole grain foods, and fish. 

From Science Daily: Healthy lifestyle may cut stroke risk in half for women

Women with a healthy diet and lifestyle may be less likely to have a stroke by more than half, according to a study. The study looked at five factors that make up a healthy lifestyle: healthy diet; moderate alcohol consumption; never smoking; physically active; and healthy body mass index (BMI). Compared with women with none of the five healthy factors, women with all five factors had a 54-percent lower risk of stroke.

For the study, 31,696 Swedish women with an average age of about 60 completed a 350-item questionnaire about their diet and lifestyle. They were then followed for an average of 10 years. A healthy diet was defined as within the top 50 percent of a recommended food score measuring how often the participants ate healthy foods such as fruits, vegetables and low-fat dairy products. Moderate alcohol consumption was defined as three to nine drinks per week. Physically active was defined as walking or biking at least 40 minutes a day along with more vigorous exercise at least one hour per week. Healthy BMI was considered below 25.

Most of the women had two or three of the healthy factors. Only 589 women had all five healthy factors, and 1,535 had none. There were 1,554 strokes among study participants. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Women who had a healthier diet were 13 percent less likely to have a type of stroke called a cerebral infarction than those whose diet was not as healthy. Women with healthier diets had a rate of 28 strokes per 10,000 women per year compared to 43 strokes per 10,000 women per year among those with a less healthy diet.

Cerebral infarction is the most common cause of stroke, accounting for up to 80 to 85 percent of all strokes. Cerebral infarction is caused by a blockage in a blood vessel preventing blood and oxygen from getting to an area of the brain.

There was no relationship between the healthy factors and the risk of hemorrhagic stroke. Hemorrhagic stroke, which is caused by bleeding in and around the brain, accounts for about 15 to 20 percent of all strokes.

Another study finding health benefits from eating dairy foods (vs not eating any dairy foods). From Science Daily:

A heart-felt need for dairy food: Small serving beneficial, large not necessary

A daily small serve of dairy food may reduce the risk of heart disease or stroke, even in communities where such foods have not traditionally formed part of the diet according to new research.

A study of nearly 4000 Taiwanese, led by Emeritus Professor Mark Wahlqvist from Monash University's Department of Epidemiology and Preventive Medicine and the Monash Asia Institute, considered the role increased consumption of dairy foods had played in the country's gains in health and longevity.

"We observed that increased dairy consumption meant lower risks of mortality from cardiovascular disease, especially stroke, but found no significant association with the risk of cancer," Professor Wahlqvist said.

Milk and other dairy foods are recognised as providing a broad spectrum of nutrients essential for human health. According to the study findings, people only need to eat small amounts to gain the benefits.

"Those who ate no dairy had higher blood pressure, higher body mass index and greater body fatness generally than other groups. But Taiwanese who included dairy food in their diet only three to seven times a week were more likely to survive than those who ate none."

For optimal results, the key is daily consumption of dairy foods -- but at the rate of about five servings over a week. One serving is the equivalent to eight grams of protein: a cup of milk, or 45 grams of cheese. Such quantities rarely cause trouble even for people considered to be lactose intolerant, Professor Wahlqvist said.

A banana a day keeps the doctor away? A recent large study found that older women who eat foods with higher amounts of potassium may be at lower risk of stroke and death, when compared to women who eat fewer potassium rich foods. The association was with ischemic stroke (caused by clot) and not hemorrhagic stroke.

Some good food sources of potassium are: bananas, cantaloupe, grapefruit, oranges, white and sweet potatoes, and white beans. The U.S. Department of Agriculture recommends that women eat at least 4700 mg of potassium daily, but in this study the average intake of the postmenopausal women was 2611 mg per day.

This study followed  90,137 postmenopausal women (aged 50 to 79 years at baseline), and followed them an average of 11 years. Now this same study needs to be done with men and women of all ages. From Science Daily:

Potassium-rich foods cut stroke, death risks among older women

Older women who eat foods with higher amounts of potassium may be at lower risk of stroke and death than women who consume less potassium-rich foods. The health benefits from potassium-rich foods are greater among older women who do not have high blood pressure. Most older American women do not eat the recommended amounts of potassium from foods.

"Our findings give women another reason to eat their fruits and vegetables. Fruits and vegetables are good sources of potassium, and potassium not only lowers postmenopausal women's risk of stroke, but also death."

Researchers studied 90,137 postmenopausal women, ages 50 to 79, for an average 11 years. They looked at how much potassium the women consumed, as well as if they had strokes, including ischemic and hemorrhagic strokes, or died during the study period. Women in the study were stroke-free at the start and their average dietary potassium intake was 2,611 mg/day. Results of this study are based on potassium from food, not supplements.

The researchers found: -Women who ate the most potassium were 12 percent less likely to suffer stroke in general and 16 percent less likely to suffer an ischemic stroke than women who ate the least. -Women who ate the most potassium were 10 percent less likely to die than those who ate the least. They also said there was no evidence of any association between potassium intake and hemorrhagic stroke, which could be related to the low number of hemorrhagic strokes in the study.

The U.S. Department of Agriculture recommends that women eat at least 4,700 mg of potassium daily. "Only 2.8 percent of women in our study met or exceeded this level. "Our findings suggest that women need to eat more potassium-rich foods. You won't find high potassium in junk food. Some foods high in potassium include white and sweet potatoes, bananas and white beans."