(Stroke. 1999;30:1772-1779.)
© 1999 American Heart Association, Inc.
Original Contributions |
Prospective Study of Calcium, Potassium, and Magnesium Intake and Risk of Stroke in Women
From the Channing Laboratory (H.I., M.J.S., J.E.M., K.R., G.A.C., F.E.S., W.C.W.) and the Division of Preventive Medicine (J.E.M., K.R., C.H.H.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and Departments of Epidemiology (M.J.S., J.E.M., C.H.H., G.A.C., W.C.W.) and Nutrition (M.J.S., W.C.W.), Harvard School of Public Health, Boston, Mass.
Correspondence to Meir J. Stampfer, MD, Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA 02115. E-mail meir.stampfer{at}channing.harvard.edu
Background and Purpose—High intakes of calcium, potassium, and magnesium have been hypothesized to reduce risks of cardiovascular disease, but only a few prospective studies have examined intakes of these cations in relation to risk of stroke.
Methods—In 1980, 85 764 women in the Nurses' Health Study cohort, aged 34 to 59 years and free of diagnosed cardiovascular disease and cancer, completed dietary questionnaires from which we calculated intakes of calcium, potassium, and magnesium. By 1994, after 1.16 million person-years of follow-up, 690 incident strokes (129 subarachnoid hemorrhages, 74 intraparenchymal hemorrhages, 386 ischemic strokes, and 101 strokes of undetermined type) had been documented.
Results—Intakes of calcium, potassium, and magnesium were each
inversely associated with age- and smoking-adjusted relative risks of
ischemic stroke, excluding embolic infarction of nonatherogenic
origin (n=347). Adjustment for other cardiovascular
risk factors, including history of hypertension, attenuated these
associations, particularly for magnesium intake. In a
multivariate analysis, women in the highest
quintile of calcium intake had an adjusted relative risk of
ischemic stroke of 0.69 (95% CI, 0.50 to 0.95;
P for trend=0.03) compared with those in the lowest
quintile; for potassium intake the corresponding relative risk was 0.72
(95% CI, 0.51 to 1.01; P for trend=0.10). Further
simultaneous adjustment for calcium and potassium intake
suggested an independent association for calcium intake. The
association of risk with calcium intake did not appear to be log
linear; the increase in risk was limited to the lowest quintile of
intake, and intakes >
600 mg/d did not appear to reduce risk of
stroke further. The inverse association with calcium intake was
stronger for dairy than for nondairy calcium intake. Intakes of
calcium, potassium, and magnesium were not related to risk of other
stroke subtypes.
Conclusions—Low calcium intake, and perhaps low potassium intake, may contribute to increased risk of ischemic stroke in middle-aged American women. It remains possible that women in the lowest quintile of calcium intake had unknown characteristics that made them susceptible to ischemic stroke.
Key Words: calcium • diet • magnesium • potassium • stroke
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