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April 15, 1998

Dietary Fat and Ischemic Stroke—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(15):1171-1173. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-15-jbk0415

In Reply.—Dr Brunner's comments underscore the usefulness of considering dietary patterns as well as individual nutrients or foods. Although we1 and others have been interested in exploring the effects of dietary patterns, the methods are not yet well established. Dr Brunner seems not to make the distinction between prediction and confounding. We agree that intakes of alcohol, fruits, and vegetables are important determinants of stroke incidence. Our aim, however, was to examine the role of fat intake after controlling for these and other variables. Although reductase inhibitor therapy reduces both cholesterol levels and stroke risk, the two may not be closely related.2 First, only approximately 10% to 15% of ischemic stroke is due to large-vessel atherosclerosis; second, much of the "astatin" effect appears in the early years of therapy; and third, some of the effect may be through reduction of coronary events, which themselves predispose to stroke.

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