Stroke Archive

In the journals

People who have had a heart attack or a stroke are routinely prescribed a statin to reduce the risk of a repeat event. But by also following a Mediterranean-style diet, they can improve their chance of living longer, suggests a study in the Feb. 1, 2019, issue of the International Journal of Cardiology.

The study looked at 1,180 people, average age 68, who had at least one previous heart attack or stroke, and recorded their statin use and diet intake at the study's beginning. The researchers identified the people who faithfully followed a Mediterranean-style diet. A Mediterranean-style diet involves consuming medium to high amounts of whole fruits and vegetables, whole grains, legumes and nuts, olive oil, and poultry and fish, with limited amounts of red meat, alcohol, and dairy.

At 70 years and counting, the Framingham Heart Study continues to help doctors better understand stroke, dementia, and heart disease.

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In 1948, more than 5,200 people living in a town just west of Boston volunteered for what has evolved into the longest running and best-known study of the causes of heart disease. But the multigenerational Framingham Heart Study has also revealed important clues about brain disorders — most notably stroke but also cognitive decline and dementia (see "Framingham's brain health findings").

In the early 1960s, Framingham researchers coined the term "risk factor," which refers to a characteristic or exposure that raises a person's odds of developing a disease. Over the following decades, they uncovered many such factors for heart disease, including cigarette smoking, obesity, lack of physical activity, and high blood pressure. These habits and conditions also turned out to predispose people to stroke and dementia, thereby establishing that what harms the heart is also bad for the brain.

People with fluctuating numbers — like blood pressure, cholesterol, and weight — may be at higher risk of heart attack, stroke, and even death.

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Most people battle "yo-yoing" at some point, when their weight, blood pressure, or some other health number keeps going up and down.

On the surface, this may not seem like a problem if you routinely hit the healthy numbers. Yet new research suggests that fluctuations like this may pose a greater health risk than staying at a single level, even if it's not a perfect one.

In the journals

Vitamin D and omega-3 fatty acid supplements have had mixed results when it comes to preventing heart attacks, strokes, and cancer in people who have already developed these problems or are at high risk for them. Yet a new study published online Nov. 10, 2018, by The New England Journal of Medicine found they may actually prevent these conditions among people who have never had these problems before.

Researchers recruited almost 26,000 people, ages 50 and older, who had no history of heart disease or cancer. The participants were divided into four groups. People in one group were given daily doses of 2,000 international units of vitamin D (an amount found to be linked to lower disease risk in observational studies) and 1 gram of a drug called Lovaza, which contained 840 milligrams of omega-3s (two to four times the amount in two servings of fish per week). The second group took vitamin D and a placebo, the third group took the omega-3s and a placebo, and the final group took two placebos. After more than five years, the researchers found that those given omega-3s were 28% less likely to suffer a heart attack compared with those given a placebo. Those who ate fewer servings of fish (less than the average of 1.5 servings per week) appeared to have a greater benefit from the additional omega-3s while those with higher fish intake had minimal benefit.

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Research we're watching

For years, many have speculated that taking vitamin D and omega-3 fatty acid supplements might help to prevent heart attacks, strokes, and certain cancers. But a study by Harvard researchers published online November 10, 2018, by The New England Journal of Medicine has found that the benefits may be more limited than originally hoped.

The results of the Vitamin D and Omega-3 Trial (VITAL), which enrolled more than 25,000 people and ran for more than five years, showed that while omega-3 supplements did appear to reduce the risk of heart attack, particularly among African Americans, they did not appear to be effective in preventing stroke or cancer. Vitamin D supplements also saw few benefits when it came to preventing heart attack, stroke, or cancer — but they were associated with a drop in cancer deaths in people who had taken the supplements for at least a year or two.

Research we're watching

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People whose daily diets include at least two servings per day of milk, yogurt, or cheese appear to have a lower risk of heart disease, stroke, or death than people who don't consume dairy products.

The findings, published Sept. 11, 2018, in The Lancet, were based on food questionnaires from more than 136,000 people from 21 countries. After a follow-up that lasted an average of nine years, researchers found that adults who consumed two or more servings of dairy each day had a 22% lower risk for heart disease, a 34% lower risk for stroke, and a 23% lower risk of heart-related death. Observational studies such as this one cannot prove cause and effect. But dairy-based foods contain vitamins D and K, calcium, and other nutrients thought to be good for cardiovascular health. The findings support the benefits of all types of dairy, including full-fat versions. However, current guidelines still recommend nonfat or low-fat milk, yogurt, and cheese, which contain fewer calories and less saturated fat.

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In the journals

People with atrial fibrillation, or afib, a type of irregular heartbeat that is linked with stroke, also may have a greater risk of dementia than those without the condition, according to a study published online Oct. 10, 2018, by Neurology.

Researchers recorded medical data from 2,685 people, average age 73. None of them had dementia and 243 had afib. After nine years, another 279 people developed afib. The researchers found that people with afib showed a faster rate of decline in thinking and memory skills than those without the condition, and were 40% more likely to develop dementia.

But use is primarily a concern for people who take them over a long period or who have certain health risks.

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Numerous studies in recent years have raised concerns that common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiovascular problems, such as heart attack and stroke.

A study published September 4 in The BMJ seems to confirm the risks associated with NSAIDs and notes that one medication in particular — diclofenac (Voltaren) — is associated with even higher risks to cardiovascular health than others in the same category.

Research we're watching

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Taking a low-dose aspirin every day could bring more risks than health benefits to healthy older adults, according to three papers from a single study, published online September 16 by The New England Journal of Medicine. The study, which began in 2010, included more than 19,000 adults ages 65 and older in the United States and Australia, who were free of cardiovascular disease, dementia, or disability, and followed participants for 4.7 years on average. Researchers found that treatment with a daily low-dose aspirin did not prevent dementia or disability. And rates of cardiovascular events (such as heart attacks and stroke) were similar between participants who took low-dose aspirin therapy and the comparison group that did not. While health outcomes were largely the same, people in the aspirin group were more likely than those who were not taking daily aspirin to experience significant bleeding, both in the gastrointestinal tract and the brain — a known risk of aspirin therapy.

While low-dose aspirin does not appear to benefit healthy older adults, this does not apply to people with known cardiovascular disease. For them, aspirin therapy significantly decreases risk of heart attack and stroke.

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Research we're watching

Eating a Mediterranean-style diet, which is rich in fruits and vegetables, lean meats, and nuts, may help women over 40 reduce the risk of stroke, according to a study published in the journal Stroke.

The study enrolled more than 20,000 adults, ages 40 to 77, who were asked to record what they ate in a seven-day diet diary. Researchers then compared their diet and their stroke risk over a 17-year period.