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Fat Chance: Title and subTitle BreakDiet and Ischemic Stroke FREE

Roger Sherwin, MB, BCh; Thomas R. Price, MD
[+] Author Affiliations

Reprints: Roger Sherwin, MB, BCh, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201.


JAMA. 1997;278(24):2185-2186. doi:10.1001/jama.1997.03550240075038
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The findings of Gillman et al1 reported in this issue of THE JOURNAL that lower levels of dietary fat are associated with a higher risk of ischemci stroke among men in the Framingham Heart Study are certainly intriguing and probably important. Although the same association has been observed in Asian2 and Asian American populations,3 this is the first such demonstration among Caucasians in a cohort study. Because lower levels of dietary fat lead to lower levels of blood cholesterol, the first instinct is to think of blood cholesterol as the mediating factor. It is true that very low levels of blood cholesterol have been consistently associated with hemorrhagic stroke.4 However, the findings of Gillman et al1 relate to ischemic stroke and persist after adjustment for blood cholesterol; this suggests that blood cholesterol is not part ofthe causal chain, if indeed there is a causal chain.

REFERENCES

Gillman MW, Cupples LA, Millen BE, Ellison RC, Wolf PA.  Inverse association of dietary fat with development of ischemìc stroke in men . JAMA . 1997;;278:2145-2150.
Omura T, Hisamatsu S, Takizawa Y, et al.  Geographical distribution of cerebrovascular disease mortality and food intakes in Japan . Soc Sci Med . 1987;;v:401-407.
McGee D, Reed D, Stemmerman G, et al.  The relationship of dietary fat and cholesterol to mortality in 10 years: the Honolulu Heart Program . Int J Epidemiol . 1985;;14:97-105.
Iso H, Jacobs DR, Wentworth D, et al.  Serum cholesterol levels and six-year mortality from stroke in 350 977 men screened for the Multiple Risk Factor Intervention Trial . N Engl J Med . 1989;;320:904-910.
Crouse JR III, Byington RP, Hoen HM, et al.  Reductase inhibitor monotherapy and stroke prevention . Arch Intern Med . 1997;;157:1305-1310.
US Dept of Agriculture and US Dept of Health and Human Services. Dietary Guidelines for Americans. Homan Garden Bull. 1995;232:1.
Menotti A, Keys A, Blackburn H, et al.  Twenty-year stroke mortality and prediction in twelve cohorts of the Seven Countries Study . Int J Epidemiol . 1990;;19:309-315.
Kimura N.  Changing patterns of coronary heart disease, stroke, and nutrient intake in Japan . Prev Med . 1983;;12:222-227.
Freedman L, Anderson G, Kipnis V, et al.  Approaches to monitoring the results of long-term disease prevention trials: examples from the Women's Health Initiative . Control Clin Trials . 1996;;17:509-525.
Ornish D, Brown SE, Scherwitz LW, et al.  Can lifestyle changes reverse coronary heart disease: the Lifestyle Heart Trial . Lancet . 1990;;336:129-133.

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Gillman MW, Cupples LA, Millen BE, Ellison RC, Wolf PA.  Inverse association of dietary fat with development of ischemìc stroke in men . JAMA . 1997;;278:2145-2150.
Omura T, Hisamatsu S, Takizawa Y, et al.  Geographical distribution of cerebrovascular disease mortality and food intakes in Japan . Soc Sci Med . 1987;;v:401-407.
McGee D, Reed D, Stemmerman G, et al.  The relationship of dietary fat and cholesterol to mortality in 10 years: the Honolulu Heart Program . Int J Epidemiol . 1985;;14:97-105.
Iso H, Jacobs DR, Wentworth D, et al.  Serum cholesterol levels and six-year mortality from stroke in 350 977 men screened for the Multiple Risk Factor Intervention Trial . N Engl J Med . 1989;;320:904-910.
Crouse JR III, Byington RP, Hoen HM, et al.  Reductase inhibitor monotherapy and stroke prevention . Arch Intern Med . 1997;;157:1305-1310.
US Dept of Agriculture and US Dept of Health and Human Services. Dietary Guidelines for Americans. Homan Garden Bull. 1995;232:1.
Menotti A, Keys A, Blackburn H, et al.  Twenty-year stroke mortality and prediction in twelve cohorts of the Seven Countries Study . Int J Epidemiol . 1990;;19:309-315.
Kimura N.  Changing patterns of coronary heart disease, stroke, and nutrient intake in Japan . Prev Med . 1983;;12:222-227.
Freedman L, Anderson G, Kipnis V, et al.  Approaches to monitoring the results of long-term disease prevention trials: examples from the Women's Health Initiative . Control Clin Trials . 1996;;17:509-525.
Ornish D, Brown SE, Scherwitz LW, et al.  Can lifestyle changes reverse coronary heart disease: the Lifestyle Heart Trial . Lancet . 1990;;336:129-133.
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