Substitution of Fish for Red Meat or Poultry and Risk of Ischemic Stroke

Stine K Venø*, Christian S Bork, Marianne Uhre Jakobsen, Søren Lundbye-Christensen, Flemming W Bach, Peter L McLennan, Anne Tjønneland, Erik B Schmidt, Kim Overvad

*Corresponding author for this work

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We investigated the risk of ischemic stroke and its subtypes when red meat or poultry was substituted with fish. A total of 57,053 participants aged 50⁻65 years at baseline were included in the Danish Diet, Cancer and Health study. All participants filled in a food-frequency questionnaire at recruitment. Potential ischemic stroke cases were identified by linkage to the Danish National Patient Register, and all cases were validated and subclassified. Substitutions were investigated as 150 g/week of fish for 150 g/week of red meat or of poultry using multivariable Cox proportional hazard regression models. During 13.5 years of follow-up, 1879 participants developed an ischemic stroke. Replacing red meat or poultry with fish was not associated with the rate of total ischemic stroke, but there was a statistically significant lower rate of large artery atherosclerosis when fish replaced processed (hazard ratio (HR): 0.78; 95% confidence interval (CI): 0.67; 0.90) and unprocessed (HR: 0.87; 95% CI: 0.75; 0.99) red meat. A statistically significant higher rate of cardioembolism was found when poultry was replaced by total fish (HR: 1.42; 95% CI: 1.04; 1.93). When fatty fish replaced unprocessed red meat, a statistically significant lower rate of small-vessel occlusion was found (HR: 0.88; 95% CI: 0.77; 0.99). In conclusion, replacing red meat with fish was not associated with risk of total ischemic stroke but was associated with a lower risk of subtypes of ischemic stroke.
Original languageEnglish
Article number1648
Issue number11
Number of pages11
Publication statusPublished - 2018


  • ischemic stroke
  • TOAST classification
  • substitution models
  • cohort studies
  • diet
  • fish
  • meat
  • poultry


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