DASH diet adherence is associated with lower ischemic stroke incidence among older women: findings from a sex-specific analysis

Background Stroke is a leading cause of death and disability, and its incidence is expected to rise. This study investigated adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and ischemic stroke incidence among older adults. Methods This cohort study used data from the Israeli Nutrition and Health Survey of adults aged ≥ 65 years, a nationwide survey conducted in Israel. DASH adherence was assessed using 24-h dietary recall and Mellen et al.’s DASH score (range: 0–9). Ischemic stroke events were identified through linkage with the Israeli National Stroke Registry (INSR), which includes nationwide stroke records from 1 January 2014, through 31 December 2022. First-ever ischemic stroke events during follow-up were included. Multivariable Fine and Gray proportional hazards models, accounting for death as a competing risk, were used to estimate subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) according to DASH adherence, with participants classified as DASH-accordant (score ≥ 4.5) or non-accordant (score < 4.5). Results Among 1,177 participants who were alive at the start of follow-up (median age in 2014, 81 years [IQR, 77–85]; 56.2% women), 60 ischemic stroke events occurred during a mean follow-up of 6.6 ± 3.0 years. A significant interaction was observed between sex and DASH adherence in relation to ischemic stroke incidence ( p = 0.002). In the sex-specific adjusted main model, including age, sex, sex and DASH interaction term, population group, socioeconomic status, energy intake, smoking and physical activity, higher DASH adherence was associated with a lower risk of first-ever ischemic stroke among women (sHR = 0.24, 95% CI: 0.08–0.68; p = 0.007). The association differed by sex, with an estimate in the opposite direction among men (sHR = 2.03, 95% CI: 0.77–5.40; p = 0.154). Analyses included all INSR first-recorded ischemic stroke (first-ever or recurrent) yielded similar findings. Conclusion Higher DASH adherence was associated with a lower risk of ischemic stroke among older women. These findings support a potential role for the DASH dietary pattern in ischemic stroke prevention and highlight the need for further investigation of sex-specific associations.