Diet and Stroke: Recent Evidence Supporting a Mediterranean-Style Diet and Food in the Primary Prevention of Stroke.

E very year there are ≈795 000 incident strokes, a leading cause of long-term disability in the United States. 1 The cost of stroke in 2010 was $36.5 billion and is projected to increase, with lost wages being the most substantial cost. 1 Identifying targets for primordial prevention of stroke is critical to public health as the population in the United States is aging. Diet is often suggested as a stroke prevention option because diet quality has effects on weight maintenance and blood pressure control beyond directly reducing the risk of stroke. 2 On the basis of impact of diet on blood pressure and cholesterol , a recent Cochrane Review estimated that dietary interventions may decrease stroke risk by 19%. 3 In addition to blood pressure and cholesterol, diet may increase the risk of stroke through other mechanisms, including insulin resistance, inflammation, thrombosis, endothelial function, and oxidation. 4 When describing diet and stroke risk, one can consider nutrients, foods, food groups, and dietary patterns. 4–8 The multiple of methods used to quantify diet can lead to confusion in terms of dietary recommendations because many studies seem to conflict with one another. Recently, in an effort to simplify and clarify nutritional recommendations , dietary pattern approaches have been the focus of national recommendations for dietary change. 9 In fact many are simply recommending a Mediterranean-style diet. 10 The Mediterranean diet refers to the dietary patterns , which were found in the olive-growing areas of the Mediterranean region in the early 1950s and 1960s and has long been associated with better cardiovascular health. In the Seven Countries Study, Ancel Keys observed that the Greek island of Crete had the lowest rates of coronary heart disease of the 7 countries, sparking interest in the Mediterranean diet. 11 Although details of this pattern may vary, the Mediterranean diet is characterized by high amounts of plant-based food, olive oil, and moderate amounts of meat, dairy, and wine. 11 This review will focus on the evidence for a Mediterranean-style diet, and the foods that characterize this diet and stroke.