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Dietary Patterns Associated With Risk of Intracranial Atherosclerosis in Older Adults With Hypertension or Myocardial
Laurel Cherian1, Puja Agarwal2, Sonal Agrawal2
1Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; and.
Insights
Intracranial atherosclerosis disease (ICAD) risk was not directly linked to diet in a large study. However, healthy eating patterns may reduce severe ICAD in individuals with hypertension or myocardial infarction.
Area of Science:
- Neurology
- Cardiovascular Science
- Nutritional Epidemiology
Background:
- Intracranial atherosclerosis disease (ICAD) is a major cause of ischemic stroke and cognitive decline.
- Understanding modifiable risk factors like diet is crucial for preventing ICAD.
- Existing research has not fully elucidated the relationship between dietary patterns and ICAD risk.
Purpose of the Study:
- To investigate the association between dietary patterns and the risk of developing intracranial atherosclerosis disease (ICAD).
- To explore potential interactions between diet, hypertension (HTN), and myocardial infarction (MI) in relation to ICAD.
- To assess the impact of specific dietary patterns on ICAD severity.
Main Methods:
- A longitudinal clinical neuropathologic cohort study including 676 participants with complete dietary, medical history, and neuropathology data.
- Dietary patterns were assessed using diet scores, including the Mediterranean-DASH intervention for neurodegenerative delay (MIND) and Mediterranean Diet (MedDiet).
- ICAD severity was graded (0-3) based on plaque presence, extent, and occlusion at the circle of Willis, with adjustments for age, sex, education, caloric intake, and APOE4.
Main Results:
- No direct association was found between overall diet patterns and ICAD risk.
- Hypertension (HTN) was significantly associated with increased ICAD risk (OR 1.598).
- Dietary associations with ICAD differed based on history of MI and HTN. Among those with prior MI, adherence to MedDiet and MIND diets was associated with lower odds of ICAD.
Conclusions:
- A direct link between diet and ICAD was not established in the general cohort.
- Stratified analyses suggest that healthy dietary patterns (MedDiet, MIND) may be beneficial in reducing severe large vessel ICAD among individuals with a history of hypertension or myocardial infarction.
- Further in vivo studies are warranted to confirm these findings in high-vascular-risk populations.
Background And Objectives:
Intracranial atherosclerosis disease (ICAD) accounts for 30% of ischemic strokes, has the highest stroke recurrence rate, and is associated with accelerated cognitive decline. This study investigates associations between diet patterns and the risk of ICAD.
Method:
Participants in a longitudinal clinical neuropathologic cohort study, with complete dietary, medical history, and neuropathology data, were included. Diet scores were computed (median interval to death = 5.9 [3.0-8.7] years). History of hypertension (HTN) and myocardial infarction (MI) were self-reported. Large vessel ICAD was evaluated at the circle of Willis, and severity of ICAD was assessed based on number of atherosclerotic plaques, extent of vessel involvement, and degree of vessel occlusion to create a 4-level grading system (0-3). All regression models were adjusted for age, sex, education, caloric intake, and APOE4.
Results:
Of the 676 participants (mean age at death = 91.1 years, SD = 6.1, 71% women), 361 (53%) had mild, 142 (21%) had moderate, and 28 (4%) had severe ICAD. There was no direct relationship between diet and ICAD. The association between ICAD and MI (OR 1.38, 95% CI 0.95-2.00) was not significant. HTN (OR 1.598, 95% CI 1.15-2.18) was positively associated with ICAD. The association of diet with ICAD differed by history of MI (Mediterranean-DASH intervention for neurodegenerative delay [MIND] [p = 0.007], MedDiet [p = 0.006]). The association between ICAD and the MIND diet also differed by whether HTN was reported (β = -0.212, SE = 0.111, p = 0.055) as did the relationship between ICAD and the MedDiet (β = -0.077, SE = 0.035, p = 0.029). In stratified analysis, among individuals with preexisting MI (N = 130), those with a better diet had lower odds of ICAD (MedDiet: OR 0.88, 95% CI 0.81-0.96; MIND: OR 0.69, 95% CI 0.53-0.90).
Discussion:
A direct relationship between diet and ICAD was not seen. Stratified analysis suggested that healthy diet may be of value for individuals with HTN or MI: In these high-risk individuals, a healthy dietary pattern is associated with lower odds of severe large vessel ICAD. In vivo studies of dietary habits and brain health, specifically in those at high vascular risk, are needed.
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