Trans fat, aspirin, and ischemic stroke in postmenopausal women

• Published in: Annals of neurology Vol. 72; no. 5; pp. 704 - 715
• Main Authors: Yaemsiri, Sirin, Sen, Souvik, Tinker, Lesley, Rosamond, Wayne, Wassertheil-Smoller, Sylvia, He, Ka
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.11.2012; Wiley-Liss; Wiley Subscription Services, Inc
• Subjects: Aged; Aspirin - adverse effects; Biological and medical sciences; Brain Ischemia - complications; Cohort Studies; Confidence Intervals; Diet; Dietary Fats, Unsaturated - adverse effects; Female; Fibrinolytic Agents - adverse effects; Humans; Medical sciences; Middle Aged; Neurology; Observation; Postmenopause; Proportional Hazards Models; Risk Factors; Stroke; Stroke - epidemiology; Stroke - etiology; Vascular diseases and vascular malformations of the nervous system; Women's Health; Womens health; Vascular disease; Human; Cerebral infarction; Stroke; Nervous system diseases; Central nervous system disease; Brain ischemia; Cardiovascular disease; Acetylsalicylic acid; Cerebrovascular disease; Cerebral disorder
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.23555

Objective: To examine the associations between dietary fat intake and ischemic stroke among postmenopausal women. Methods: We conducted a prospective cohort study of 87,025 generally healthy postmenopausal women (age, 50–79 years) enrolled in the Women's Health Initiative Observational Study. Repeated and validated dietary assessments were done using a self‐administered food frequency questionnaire. We used Cox proportional hazards models to estimate hazard ratios (HRs) of ischemic stroke based on quintiles of the cumulative average of fat intake. Results: We documented 1,049 incident cases of ischemic stroke over 663,041 person‐years of follow‐up. Women in the highest quintile of trans fat intake had a significantly higher incidence of ischemic stroke (HR, 1.39; 95% confidence interval [CI], 1.08–1.79; p‐trend = 0.048) compared with women in the lowest quintile, while controlling for multiple covariates. The observed association was modified by aspirin use (p‐interaction = 0.02). The HR was 1.66 (95% CI, 1.21–2.36; p‐trend < 0.01) among baseline non‐aspirin users (n = 67,288) and 0.95 (95% CI, 0.60‐1.48; p‐trend = 0.43) among aspirin users (n = 19,736). No significant associations were found between intakes of saturated, monounsaturated, or polyunsaturated fat and ischemic stroke or any ischemic stroke subtypes. Interpretation: In this large cohort of postmenopausal women, higher intake of trans fat was associated with incident ischemic stroke independent of major lifestyle/dietary factors. Aspirin use may attenuate the potential adverse effect of trans fat intake on ischemic stroke. ANN NEUROL 2012;72:704–715