Mediterranean diet and the risk of stroke subtypes in women – The California Teachers Study

Mediterranean diet (MeDi) has been linked to lower incidence of cardiovascular and neurodegenerative diseases, and overall mortality, in several prospective studies. There are limited data, however, regarding the relationship between MeDi and stroke subtypes. Researchers hypothesised that MeDi would be associated with a lower incidence of total, ischemic, and haemorrhagic stroke.
The California Teachers Study is a prospective cohort study that comprises 133,477 women who were educators and administrators enrolled in 1995–1996 and followed since. The researchers identified incident strokes using linked California state hospitalisation data and national death records from 1996 to 2020. The MeDi adherence score (range 0–9, higher score indicating better adherence) was calculated based on participants’ response to the Block food frequency questionnaire at study baseline. The association between MeDi score and risk of stroke and its subtypes was assessed, adjusted for sociodemographic, lifestyle, and vascular risk variables.
A total of 105,614 participants were eligible and included in the final analytic cohort (mean age 52.5 ± 13.8 years). Over the follow-up period (average follow-up time was 20.5 years), there were 4,083 incident stroke events (3,358 ischemic; 725 haemorrhagic). In fully adjusted models for all stroke, ischemic, and haemorrhagic subtypes, there was a lower risk of stroke among those with MeDi scores of 6–9 compared with those with scores of 0–2 (all stroke HR 0.82, 95% CI 0.74–0.92; ischemic HR 0.84, 95% CI 0.75–0.95; haemorrhagic HR 0.75, 95% CI 0.58–0.97).
Adherence to the MeDi is associated with lower risk of total, ischemic, and haemorrhagic stroke among women. Potential study limitations include recall bias, misclassification bias, and residual confounding, which would bias our results to the null.
Source: Sherzai, A.Z., et al. Mediterranean diet and the risk of stroke subtypes in women: the California Teachers Study. Neurology Open Access. (2026)