Dietary Patterns Associated With Risk of Intracranial Atherosclerosis in Older Adults With Hypertension or Myocardial Infarction.

Abstract

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. 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. 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] [<i>p</i> = 0.007], MedDiet [<i>p</i> = 0.006]). The association between ICAD and the MIND diet also differed by whether HTN was reported (β = -0.212, SE = 0.111, <i>p</i> = 0.055) as did the relationship between ICAD and the MedDiet (β = -0.077, SE = 0.035, <i>p</i> = 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). 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.