Risk factors, diet and carotid atheromatosis in TIAs and minor ischemic strokes (MISs) in a Mediterranean country.

Eighty-two patients with transient ischemic attacks (TIAs) or minor ischemic strokes (MISs) were prospectively recruited from the emergency room of a general hospital within 1 month of the event with the aim of providing a group for comparison - regarding the pathogenetic profile - with similar series from Northern Europe and USA. Patients were asked a diet questionnaire, and serum lipid analysis, CT scan and carotid duplex were performed in each case. Relevant features were antecedents of hypertension in 61%, current smoking in 23.2% and ischemic heart disease in 13.5%; mean serum levels of cholesterol 6.2 mmol/l, LDL- C, 4.27, HDL-C, 1.24, triglycerides 1.45; and duplex evidence of severe extracranial carotid atheromatosis (hemodinamically significant stenosis or occlusion) in 14.4%. Relevant diet data were daily intake of energy, 7.2 MJ, fat 34% of energy and saturated fat 12.6%. Cases with severe carotid atheromatosis had significantly lower levels of HDL-C, higher levels of triglycerides and lower per cent of energy from monounsaturated fat (p < 0.05 Mann-Whitney test). When compared with series from Northern Europe and USA ours showed lower incidence of severe carotid atheromatosis and ischemic heart disease, lower levels of triglycerides and higher HDL-C, and lower mean diet energy and proportion of unsaturated fat We suggest that higher HDL-C and lower triglyceride serum levels could be protective against severe extracranial carotid atheromatosis and that a Mediterranean diet, with less saturated fat and more monounsaturated fat could account in part for this low incidence of severe carotid disease in our TIAs and MISs patients.