Stroke ranks as the second-leading cause of death worldwide as well as the third-leading cause of death and disability combined.1 Women have a greater lifetime risk of stroke than men—in part because women live longer, on average, than men do, and because stroke risk in women rises sharply after menopause.2
A substantial body of evidence shows that the Mediterranean Diet (MeDi) reduces stroke risk in both women and men, but little has been published on the MeDi’s effects by stroke type in women.3 In
the US, about 80% of strokes are ischemic—a clot blocks blood flow to or within the brain—and the remainder are hemorrhagic, in which a blood vessel in the brain ruptures and bleeds.4
The journal Neurology Open Access recently published an analysis of data from the California Teachers Study (CTS), which followed more than 130,000 women for more than 25 years, starting in 1995.3 This analysis excluded those with a history of stroke or with missing dietary data, for a total cohort of 105,614 women. Average age at the study’s outset was 52.3
At the start of the study, participants answered a validated dietary questionnaire that asked how often they consumed 103 food and beverage items/groups during the previous year, and in what quantities
(small, medium, large serving size). Responses were converted to a score that reflected adherence to the Mediterranean Diet (MeDi), ranging from 0 to 9. Participants were stratified by MeDi scores into low (0–2), moderate (3–5), and high (6–9) MeDi adherence groups: 12.5% low, 57.5% moderate, 30% high.3
MeDi is typically characterized by high intake of fruits and vegetables, legumes, and whole grains, with olive oil as the primary source of fat; a moderate intake of fish; and minimal intake of meat and dairy products. Some versions of the MeDi include moderate alcohol consumption.3
During the 25 years of follow-up, the CTS study population experienced a total of 4,083 stroke events: 3,358 ischemic and 725 hemorrhagic.3
Participants with high adherence to the MeDi had a 23% lower overall stroke risk compared with the low-adherence group. When results were adjusted for patient characteristics, including smoking, BMI, and demographics, overall stroke risk was still reduced by 18% with high adherence to the MeDi. Even a one-unit increase in MeDi adherence was associated with a significant decrease in stroke risk.3
When analyzed by stroke subtypes, higher adherence to the MeDi resulted in a significant decrease
in stroke risk for ischemic stroke as well as for hemorrhagic stroke. This effect was seen across premenopausal, menopausal, and postmenopausal women in the study, including participants taking hormone treatment.3
This study, with strengths including a large population, long-range follow-up, and analysis by stroke subtype, adds to the body of evidence of the preventative health benefits of the MeDi and helps identify dietary choices that can help reduce stroke risk in women.3
References: 1. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization (WSO): Global stroke fact sheet 2022 [published correction appears in Int J Stroke. 2022;17(4):478. doi:10.1177/17474930221080343]. Int J Stroke. 2022;17(1):18–29. 2. Rexrode KM, Madsen TE, Yu, AYX, Carcel C, Lichtman JH, Miller EC. The impact of sex and gender on stroke. Circulation Res. 2022;130(4):512-528. 3. Sherzai AZ, Cuble EL, Spielfogel ES, et al. Mediterranean diet and the risk of stroke subtypes in women. Neurol Open Access. 2026;2:e000062. 4. Prabhakaran S, Gonzales NR, Zachrison KS, et al. 2026 guideline for the early management of patients with acute ischemic stroke. Stroke. 2026; doi:10.1161/STR.0000000000000513. Online ahead of print.