Adults With Hypertension or Myocardial Infarction

A healthy diet can be a powerful tool in preventing or slowing the progression of cardiovascular and Intracranial Atherosclerosis. Recent research led by Laurel Cherian and colleagues examined how specific dietary patterns relate to the severity of intracranial atherosclerotic disease (ICAD) in older adults—particularly those with a history of hypertension or myocardial infarction. This comprehensive study offers valuable insights into how the Mediterranean diet, the MIND diet, and other healthy eating approaches may influence stroke risk and vascular health in high-risk seniors.

Why Intracranial Atherosclerosis Matters

Intracranial atherosclerosis occurs when plaque builds up in the arteries inside the skull, reducing blood flow to the brain. This condition accounts for nearly one-third of ischemic strokes and carries the highest recurrence rate among stroke subtypes. Beyond stroke, ICAD is linked to accelerated cognitive decline and dementia. Because older adults often have coexisting vascular risk factors such as hypertension and myocardial infarction (MI), understanding modifiable influences—especially diet—is crucial.

Study Design and Population

The research analyzed data from 676 participants in a longitudinal neuropathologic cohort. All participants:

• We were aged 80 and older (mean age at death: 91.1 years, SD 6.1), with 71% women
• Provided detailed dietary histories via validated food frequency questionnaires
• Reported medical histories for hypertension and MI
• Underwent post-mortem evaluation of large arteries at the circle of Willis to grade ICAD severity

Diet quality was assessed using three established scoring systems:

• MIND Diet Score (Mediterranean-DASH Intervention for Neurodegenerative Delay)
• Mediterranean Diet (MedDiet) Score
• A general healthy eating index

ICAD severity was categorized on a four-point scale (0=no disease; 3=severe disease) based on plaque count, vessel involvement, and degree of occlusion. Regression models adjusted for age, sex, education, total caloric intake, and APOE4 genotype.

Key Findings

No Direct Diet–ICAD Link in Overall Cohort

When analyzing all participants regardless of medical history, no statistically significant association was observed between overall diet quality and ICAD severity. This suggests that in very late life, dietary patterns alone may not directly correlate with intracranial plaque burden.

Hypertension and ICAD

Hypertension emerged as a strong, independent risk factor for ICAD. Participants who reported a history of hypertension had 1.6-times greater odds of moderate to severe ICAD compared to those without hypertension (OR 1.60, 95% CI 1.15–2.18).

Diet Benefits in High-Risk Subgroups

Strikingly, healthy dietary patterns were associated with lower ICAD severity among individuals with prior MI or hypertension:

• Myocardial Infarction Subgroup (n=130)
  • Every one-point increase in MedDiet score corresponded to a 12% lower odds of severe ICAD (OR 0.88, 95% CI 0.81–0.96).
  • Each point increase in MIND score yielded a 31% reduction in severe ICAD odds (OR 0.69, 95% CI 0.53–0.90).
• Hypertension Subgroup
  • Trends indicated similar protective associations for MIND and MedDiet scores, though p-values hovered near significance (MIND: β=-0.212, p=0.055; MedDiet: β=-0.077, p=0.029).

These stratified analyses suggest that older adults with established vascular disease stand to gain the most from consuming a plant-rich, antioxidant-packed, low-saturated-fat diet.

Understanding the Mediterranean and MIND Diets

Mediterranean Diet

Characterized by daily consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil; moderate intake of fish and poultry; low intake of red meat, sweets, and saturated fats. Multiple studies link the MedDiet to lower cardiovascular and neurodegenerative disease risk.

MIND Diet

A hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, the MIND diet emphasizes brain-healthy foods:

• “Green light” groups: green leafy vegetables, berries, nuts, whole grains, olive oil, fish, beans, and poultry
• “Red light” foods to minimize: red meat, butter, cheese, pastries, and fried foods

Epidemiologic evidence associates higher MIND scores with slower cognitive decline and reduced Alzheimer’s disease risk.

Practical Dietary Recommendations

For older adults with hypertension or prior MI, adopting a Mediterranean-style or MIND dietary pattern may help mitigate intracranial plaque progression and stroke risk. Key actionable steps include:

• Center meals around plant foods: aim for at least 5 servings of vegetables and fruits daily.
• Replace butter and margarine with extra virgin olive oil as the primary fat source.
• Include fatty fish (e.g., salmon, sardines) at least twice per week to boost anti-inflammatory omega-3 intake.
• Consume berries (especially blueberries and strawberries) at least 3 times per week to leverage antioxidant benefits.
• Opt for whole grains (oats, brown rice, quinoa) over refined grains to improve vascular health.
• Limit red meat to no more than 3 servings per week, choosing lean poultry or plant-based proteins instead.
• Minimize processed foods, sugary beverages, and high-sodium snacks to control blood pressure and lipid levels.

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Conclusion

Although diet quality alone did not predict intracranial atherosclerosis in the overall cohort of very old adults, participants who followed healthful dietary patterns—particularly the Mediterranean and MIND diets—experienced significantly lower ICAD severity if they had hypertension or a prior myocardial infarction. For older adults at high vascular risk, prioritizing plant-forward, antioxidant-rich, and low-saturated-fat foods offers a promising strategy to reduce stroke risk and support brain health.