Vegetarian Longevity: Nutritional Determinants of Exceptional Aging Across the Life Course

The scientific study of human longevity has evolved from demographic description to mechanistically informed nutritional epidemiologyThe branch of epidemiology that studies relationships between dietary patterns and disease outcomes in populations, relying primarily on observational data such as food-frequency questionnaires and disease registries.. Across multiple cohorts, plant-dominant dietary patterns are consistently associated with reduced cardiometabolic disease, lower incidence of several cancers, and improved overall survival. Yet longevity is not a single metabolic state sustained unchanged from mid-life into extreme old age. Aging alters proteinProtein is the nutrient your body uses to build and repair muscle and tissue. metabolism, micronutrient vulnerability, inflammatory signaling, and the physiological trade-offs between protection from chronic disease and protection from frailty. As a result, the dietary pattern that minimizes risk at age 50 may not be identical to the pattern that maximizes resilience and survival probability at age 90.

This manuscript integrates evidence from the Adventist Health StudiesA series of long-running prospective cohort studies examining health outcomes in Seventh-day Adventists, a population with high rates of vegetarianism; findings include a 62% lower risk of type 2 diabetes in vegans compared to non-vegetarians, independent of body weight., traditional longevity populations (with particular focus on Okinawa), the China–Cornell–Oxford ProjectA large ecological study conducted in the 1980s comparing diet patterns, biomarkers, and disease mortality across rural Chinese counties with largely plant-based diets; it reported dramatically lower coronary artery disease mortality and substantially lower serum cholesterol levels in rural China compared with the United States., the Chinese Longitudinal Healthy Longevity Survey (CLHLS)A long-running longitudinal study of elderly and oldest-old adults in China, widely used to examine survival, diet, and healthspan in people aged 80 and above, including centenarians., and major strokeA stroke happens when blood flow to part of the brain stops, either from a blockage or from bleeding. cohorts to construct a life-course, age-calibrated model of longevity nutrition.

The Adventist Health Studies: Mortality Gradients in a Low-Confounding Cohort

The Seventh-day Adventist population in North America provides one of the most methodologically valuable settings for nutritional epidemiologyEpidemiology is the study of health patterns in large groups of people — who gets sick, where, and what they had in common., in part because smokingSmoking damages the lining of your blood vessels, raises blood pressure, makes blood clot more easily, and speeds up plaque growth. and alcoholAlcohol is the ingredient in beer, wine, and spirits that makes them intoxicating. use are uncommon, lowering major behavioral confoundingConfounding is when a hidden third factor makes two unrelated things look connected. relative to general-population cohorts. In Adventist Health Study-2 (AHS-2)A large prospective cohort study of approximately 96,000 Seventh-day Adventists in North America, valued in nutritional epidemiology because low rates of smoking and alcohol use in this population reduce major behavioral confounders, allowing cleaner assessment of dietary patterns on mortality and disease outcomes., 73,308 participants were followed for a mean of 5.79 years and 2,570 deaths were recorded, corresponding to a mortality rate of 6.05 per 1,000 person-years [1]. Vegetarian dietary patterns were associated with significantly lower all-cause mortalityAll-cause mortality means death from any cause at all, not just heart disease — the broadest, hardest-to-game outcome a study can measure. compared with non-vegetarians after multivariable adjustment (HR 0.88; 95% CI 0.80–0.97) [1].

Table 1. AHS-2 Dietary Patterns and All-Cause Mortality [1]

Dietary Pattern	Hazard RatioA hazard ratio compares how quickly events happen in two groups. A ratio of 0.75 means events occurred at three-quarters the rate in the treated group. (HR)	95% CI
Non-vegetarian	1.00	Reference
Vegan	0.85	0.73–1.01
Lacto-ovo vegetarian	0.91	0.82–1.00
Pesco-vegetarianA dietary pattern that excludes meat and poultry but includes fish and seafood alongside plant foods; in the AHS-2 cohort, pesco-vegetarians showed the strongest survival advantage of any dietary subgroup studied.	0.81	0.69–0.94
Semi-vegetarian	0.92	0.75–1.13

Within the vegetarian spectrum, pesco-vegetarians demonstrated the most pronounced survival advantage [1]. This pattern is biologically plausible: adding marine-derived omega-3 fatty acidsOmega-3s are fats found mainly in oily fish, walnuts, and flaxseed. (EPA/DHA) to a plant-dominant dietary base may enhance anti-inflammatory signaling, endothelial functionThe ability of the inner lining of blood vessels to regulate vascular tone, inflammation, and clotting; healthy endothelial cells release nitric oxide to keep arteries relaxed and resistant to plaque formation., and arrhythmia protection, while preserving the lower saturated fatSaturated fat is the kind that stays solid at room temperature — butter, the fat in red meat, coconut oil, and palm oil. and higher fiberFiber is the part of plant food your body cannot digest. It is found in beans, oats, vegetables, fruit, and whole grains. typical of plant-forward eating.

Cause-specific analyses from the AHS-2 cohort further support clinically relevant differences beyond all-cause mortality. In particular, vegetarian-pattern adherenceAdherence means actually taking your medicine the way it was prescribed, day after day. is associated with lower mortality from several non-cancer causes, including kidney-related outcomes in some analyses, consistent with mechanisms such as lower dietary acid load, improved blood pressureBlood pressure is the force of blood pushing against your artery walls. It is written as two numbers, like 120/80. The top number is the pressure when your heart squeezes, the bottom is when it relaxes. profiles, and reduced metabolic burden on renal clearance pathways [2]. Importantly, these findings also illustrate that “vegetarian” is not nutritionally uniform: protein source diversity, micronutrient adequacy (especially B12), and overall diet quality substantially shape outcomes and likely contribute to between-cohort differences observed globally.

Okinawa and Other Longevity Populations: Macronutrient Distribution, IGF-1, and mTOR Signaling

Traditional longevity populations are often described as ecological corroboration of plant-centric dietary patterns, though they should not be interpreted as controlled trials. Okinawa is notable because its pre-Westernization dietary pattern was characterized by a very high carbohydrateCarbohydrates are the sugars and starches in food — bread, rice, pasta, fruit, potatoes, sweets. share, low protein share, and high micronutrient density. Analyses of traditional Okinawan intake patterns have described a carbohydrate-to-protein ratio near 10:1, with macronutrient distribution approximating 85% carbohydrate, 9% protein, and 6% fat (by energy intake) [3,4]. Sweet potatoes were a dominant caloric source, contributing fiber and phytochemicals alongside stable caloric availability.

Mechanistically, lower protein intake—particularly lower essential amino acid exposure—can reduce circulating insulin-like growth factor-1 (IGF-1), a pathway associated with increased cellular proliferation and cancer biology. Reduced IGF-1 signaling can suppress activation of mechanistic target of rapamycinA pharmacologic inhibitor of mTORC1 that reproducibly extends lifespan and healthspan in multiple model organisms, including mice, even when started late in life; it is used experimentally to study the role of mTOR in aging, though its clinical use in healthy humans for longevity remains investigational. (mTOR), a central nutrient-sensing pathway implicated in aging, cellular growth, and autophagyAutophagy is a cellular housekeeping process by which cells break down and recycle damaged proteins and organelles; in arterial macrophages, it helps clear lipid debris and prevents the accumulation of plaque. The article's 2024 Nature Metabolism finding suggests that high single-meal protein doses may suppress autophagy in these immune cells, potentially worsening atherosclerosis in animal model… regulation [5]. Mild chronic moderation of mTOR activity is associated with increased autophagic flux, improved mitochondrial turnover, and enhanced cellular stress resistance—features often proposed as contributors to slowed biological aging.

In addition, the plant-forward nature of these diets usually entails high legume and fiber intake. Fermentable fiber supports gut microbial production of short-chain fatty acids (SCFAs)Metabolites—primarily butyrate, propionate, and acetate—produced when gut bacteria ferment dietary fiber; butyrate in particular exerts anti-inflammatory effects and influences gene expression through inhibition of histone deacetylase enzymes., particularly butyrateA short-chain fatty acid produced when gut bacteria ferment dietary fiber; it strengthens the intestinal barrier, reducing the leakage of bacterial toxins (such as LPS) into the bloodstream that would otherwise drive systemic inflammation., which exerts anti-inflammatory effects and epigenetic regulation (including histone deacetylase inhibition) relevant to immune aging and metabolic stability [6]. These microbiome-mediated effects are highly sensitive to diet quality (whole plant foods vs. refined starches), reinforcing that “plant-based” is not automatically synonymous with “high quality.”

Crucially, traditional longevity diets are rarely strictly vegan. Small quantities of fish or meat are often consumed episodically, typically in culturally structured ways. The defining commonality appears to be plant dominance, not absolute animal exclusion.

The China–Cornell–Oxford Project: Lipid Gradients and Cardiovascular Mortality

The China–Cornell–Oxford Project provided a large-scale comparative view of diet patterns and disease gradients across rural Chinese populations in the 1980s, many of which consumed predominantly plant-based dietsA plant-based, or plant-predominant, diet is built mostly around vegetables, fruit, beans, whole grains, nuts, and seeds, with animal foods limited or absent.. Coronary artery diseaseCoronary artery disease is plaque buildup in the arteries feeding the heart muscle. mortality was reported as dramatically lower in rural China than in the United States, with sex-stratified differences often cited in analyses of the dataset [7]. Mean serum cholesterolCholesterol is a waxy substance your body needs. It goes into cell walls, hormones, vitamin D, and the bile that digests your food. You would die without it. levels also differed substantially between settings: approximately 127 mg/dL in rural China versus 215 mg/dL in the United States in commonly cited comparisons [7].

Rather than treating these values as a simplistic “lower is always better” conclusion, later vascular epidemiology emphasizes context: while lower LDLLDL, or low-density lipoprotein, is the main particle that carries cholesterol through your blood — and the main one that gets stuck in artery walls. and total cholesterolTotal cholesterol adds together the cholesterol in all your particles, harmful and helpful alike. are strongly associated with lower ischemic heart diseaseA condition in which reduced blood supply to the heart muscle, usually from coronary artery atherosclerosis, causes symptoms such as angina or myocardial infarction. risk in many populations, extremely low cholesterol has been linked in some datasets to higher hemorrhagic strokeA hemorrhagic stroke is a type of stroke caused by bleeding into or around the brain rather than by a blocked artery; because aspirin impairs clotting, it raises the risk of this complication, which is a key reason its use in low-risk individuals is now discouraged. risk, suggesting a potentially non-linear (sometimes described as U-shaped) relationship depending on baseline risk factorsA risk factor is something that raises your chance of developing a disease — high cholesterol particles, high blood pressure, smoking, diabetes, family history. and stroke subtype distributions. This nuance becomes important when comparing Western vegetarian cohorts to East Asian cohorts with different stroke epidemiology and dietary micronutrient patterns.

The Oldest-Old and the Protein Paradox: CLHLS Evidence on Centenarian Likelihood

Mid-life advantages do not automatically extrapolate into the tenth decade of life. A CLHLS-based nested case-control analysis of Chinese adults aged ≥80 years examined dietary patterns in relation to the likelihood of reaching age 100 and reported an inverse association between strict vegetarian patterns and centenarian likelihood in that context [8]. Reported estimates included an odds ratio of 0.81 (95% CI 0.69–0.96) for vegetarians relative to omnivores, and 0.71 (95% CI 0.54–0.98) for vegans in the strictest category definitions in the report [8].

Table 2. CLHLS Dietary Pattern and Likelihood of Reaching 100 [8]

Diet Type	Odds Ratio (OR)An odds ratio is a statistical measure expressing how much more (or less) likely an outcome is in one group compared with another; an OR of 1.71 for ApoB and coronary heart disease means that genetically higher ApoB is associated with 71% higher odds of developing the disease.	95% CI
Omnivore	1.00	Reference
Vegetarian	0.81	0.69–0.96
Vegan	0.71	0.54–0.98
Pesco-vegetarian	0.84	0.64–1.09
Lacto-ovo vegetarian	0.92	0.72–1.18

A critical interpretive feature in oldest-old nutrition is confounding by frailty and reverse causationReverse causation is when the arrow points the other way — the illness caused the exposure rather than the exposure causing the illness.. Late-life dietary reporting can reflect illness, functional impairment, dentition limitations, or socioeconomic constraints rather than lifelong dietary ideology. Additionally, the analysis reported that disadvantages were concentrated among underweight participants (BMI <18.5 kg/m²), implying that undernutrition and frailty may be the operative drivers, not vegetarianism per se [8]. This aligns with geriatric clinical models: in extreme old age, the risk balance shifts toward preserving muscle mass, immune competence, and energy sufficiency.

The CLHLS itself is a major longitudinal platform for aging research in China, widely used for survival and healthspanHealthspan is the portion of a person's life spent in good health, free from serious disease, disability, or significant functional decline, as distinguished from total lifespan, which counts all years alive regardless of health status. analyses in the oldest-old [9].

Sarcopenia, Anabolic Resistance, and Age-Dependent Protein Effects

Aging is associated with anabolic resistanceAnabolic resistance is when older muscles stop responding well to protein. A younger person can eat a modest amount of protein and build muscle. An older person eating the same amount may build almost none., in which skeletal muscle becomes less responsive to a given dose of protein and to resistance exercise stimuli. Experimental physiology suggests older adults require higher per-meal essential amino acid exposure—especially leucineLeucine is one of the building blocks of protein, and the one that acts as a switch telling muscle to start rebuilding itself.—to robustly stimulate muscle protein synthesis [10]. If protein intake or caloric intake is insufficient, sarcopeniaSarcopenia is the progressive loss of muscle mass and strength that comes with age. progression accelerates, worsening fall risk, disability, immune dysfunction, and vulnerability to acute illness.

Serum albuminA protein synthesized by the liver that serves as a key marker of nutritional status and overall protein adequacy; low serum albumin in older adults is consistently associated with higher mortality risk and is used clinically as an indicator of frailty and undernutrition. and related markers of nutritional status are strongly prognostic in older adults; lower albumin is consistently associated with higher mortality risk in cohorts enriched for sarcopenia vulnerability [11]. In this framework, dietary pattern “purity” becomes less relevant than achieving sufficient protein quality, energy intake, and micronutrient adequacy.

Notably, protein intake shows age-dependent associations with mortality. In adults aged 50–65, high protein intake was associated with higher cancer mortality in a widely discussed analysis (HR 4.33; 95% CI 1.96–9.56), whereas in adults >65, higher protein intake was associated with reduced cancer mortality (HR 0.40; 95% CI 0.23–0.71) [12]. While these observational findings should not be over-interpreted as causal proof, they support a life-stage model: lower protein exposure may be protective in mid-life, but protein adequacy becomes protective in later life as frailty risk rises.

Stroke Risk Divergence Across Populations: EPIC-Oxford vs Taiwan Cohorts

Stroke outcomes illustrate why cohort context matters. In EPIC-OxfordA large UK-based prospective cohort that recruited a substantial proportion of vegetarians and vegans, forming part of the broader European Prospective Investigation into Cancer and Nutrition; it reported higher total stroke risk—driven by hemorrhagic stroke—among vegetarians compared with meat-eaters., vegetarians exhibited higher total stroke risk (HR 1.20; 95% CI 1.02–1.40), driven primarily by hemorrhagic stroke [13]. Proposed mechanisms include very low LDL cholesterolLDL cholesterol, or LDL-C, is the amount of cholesterol sitting inside your LDL particles. It is the number on almost every standard lab report., lower levels of certain fat-soluble nutrients, and vitamin B12 deficiency leading to elevated homocysteineA sulfur-containing amino acid whose blood levels rise when vitamin B12 or folate is deficient; elevated homocysteine is associated with increased vascular risk, including stroke, through effects on endothelial function and vascular integrity.—each plausibly affecting vascular integrity and hemorrhagic risk.

In contrast, Taiwanese vegetarian cohorts reported markedly lower ischemic strokeAn ischemic stroke happens when blood flow to part of the brain is blocked and brain tissue starts to die. risk (HR 0.26; 95% CI 0.08–0.88) and lower total stroke risk (HR 0.52; 95% CI 0.33–0.82) [14]. These differences likely reflect diet composition (e.g., high soy intake, higher whole-food plant density), baseline micronutrient patterns, and broader lifestyle factors. Taken together, the stroke literature argues against simple “vegetarian equals lower stroke risk” generalizations and instead supports a model where diet quality and micronutrient sufficiency (especially B12) are decisive.

Micronutrient Density and Centenarian Metabolic Profiles

Longevity appears influenced not solely by macronutrient ratios, but by micronutrient density and metabolic resilience. BiomarkerA biomarker is something measurable in the body that tells you about health or disease — a lab value, a scan result, a blood pressure reading. and metabolite studies of healthy Chinese centenarians report distinctive patterns involving essential elements (including selenium, zinc, and manganese) and metabolite signatures consistent with higher fiber fermentation and SCFA exposure [6]. Selenium contributes to antioxidantAn antioxidant is a substance that mops up damaging molecules in the body. Vitamin E and beta-carotene are examples. defense systems (e.g., glutathione peroxidase), zinc supports immune integrity, and vitamin B12 sufficiency protects against hyperhomocysteinemia-associated vascular and neurologic risk—linking micronutrient adequacy directly to late-life outcomes.

Synthesis: A Life-Course Model of Longevity Nutrition

Across cohorts, the most defensible interpretation is not a single static prescription but an age-calibrated framework:

Mid-life (40–65):
A plant-dominant, nutrient-dense dietary pattern with moderate (not excessive) protein intake may reduce cardiometabolic disease risk and may lower cancer risk partly through IGF-1/mTOR pathway modulation [1,5,12].

Early late-life (65–80):
Protein needs rise relative to mid-life, with emphasis on distribution across meals and sufficient leucine/essential amino acids to preserve lean massThe portion of body weight attributable to muscle, bone, and organs rather than fat; higher lean mass is associated with better metabolic health and is identified in the article as an upstream genetic driver of both VO₂ max and longevity. and function [10].

Oldest-old (≥80):
Priority shifts to caloric adequacy, protein quality/diversity, and micronutrient sufficiency. Avoiding underweight and preventing frailty become primary determinants of survival probability, which may explain why strict vegetarian patterns can appear disadvantageous in oldest-old observational analyses when they correlate with undernutrition [8,11].

Longevity emerges less from rigid dietary exclusion than from adaptive nutritional calibration across decades of life: metabolically protective in mid-life, and resilience-preserving in advanced age.

---

The Longevity Pivot: Why Your Diet Should Change as You Age

For decades, the “gold standard” for a long life has been clear: a whole-food, plant-based, low-fat diet. The data from the Adventist Health Study-2 and the China Study are staggering, showing profound reductions in heart disease, diabetesDiabetes is a condition where blood sugar stays too high, either because the body makes too little insulin or because it stops responding to the insulin it makes., and cancer.

However, emerging research suggests a fascinating “Protein Paradox.” The dietary strategy that keeps you alive and disease-free at 55 may not be the same one that helps you thrive at 95. To reach 100, we must move from a model of “Disease Prevention” to a model of “Frailty Defense.”

The Mid-Life Defense (Ages 40–65)

In our middle years, the goal is to keep the “biological engine” clean. High-protein diets, especially those rich in animal products, can overstimulate growth pathways like mTOR and IGF-1. Think of mTOR as a construction foreman; in mid-life, we don’t want too much “new construction” (which can include cancer cells).

• The Strategy: Plant-dominant, lower-protein, high-fiber.
• The Benefit: Suppressing these growth pathways encourages autophagy—the body’s internal cellular “cleanup” service.

The Late-Life Complexity (Ages 75+)

As we cross into the “oldest-old” category (80+), the data shifts. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) found that strict vegetarians over age 80 actually had a lower likelihood of reaching 100 than omnivores, particularly if they were underweight.

The culprit? Anabolic Resistance. As we age, our muscles become “deaf” to the signal of protein. We need more of the building blocks—specifically the amino acid leucine—just to maintain the muscle we already have.

The “Protein Paradox” by the Numbers

Research by Levine et al. highlights this life-stage flip perfectly:

• Age 50–65: High protein is associated with a 4x increase in cancer mortality.
• Age 65+: High protein is associated with a 60% reduction in cancer mortality.

How to Navigate the “Longevity Pivot”

If you are a lifelong plant-based eater, you don’t need to abandon your values, but you do need to recalibrate your chemistry.

1. Hit the “Leucine Trigger”

To overcome anabolic resistance, aim for 2.5 to 3 grams of leucine per meal. For a plant-based athlete, this means focusing on:

• Tempeh and Tofu
• Lentils and Pumpkin Seeds
• High-quality, gluten-free pea protein isolates

2. Prioritize Caloric Density

Avoid “Volume Fatigue.” If a giant bowl of salad makes you too full to eat your protein and healthy fats, you risk losing “physiologic reserve.” Incorporate walnuts, avocados, and ground flaxseeds to keep your BMI in a healthy, protective range.

3. Supplement Smart

Because nutrient absorption (B12, Zinc, Magnesium) declines with age, the “oldest-old” benefit from a food-first, supplement-supported model to maintain bone density and cognitive clarity.

The Bottom Line

Longevity isn’t about picking one diet and sticking to it forever. It’s about adaptive calibration. We spend the first half of our lives keeping the “gunk” out of our arteries, and the second half ensuring we have the muscle and strength to enjoy the years we’ve gained.

References

1. Orlich MJ, Singh PN, Sabaté J, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013;173(13):1230-1238. doi:10.1001/jamainternmed.2013.6473
2. Abris GP, Shavlik DJ, Mathew RO, et al. Cause-specific and all-cause mortalities in vegetarian compared with those in nonvegetarian participants from the Adventist Health Study-2 cohort. Am J Clin Nutr. 2024;120(4):907-917. doi:10.1016/j.ajcnut.2024.07.028
3. Willcox BJ, Willcox DC, Todoriki H, et al. Caloric restriction, the traditional Okinawan diet, and healthy aging: the diet of the world’s longest-lived people and its potential impact on morbidity and life span. Ann N Y Acad Sci. 2007;1114:434-455. doi:10.1196/annals.1396.037
4. Le Couteur DG, Solon-Biet S, Wahl D, et al. New Horizons: Dietary protein, ageing and the Okinawan ratio. Age Ageing. 2016;45(4):443-447. doi:10.1093/ageing/afw069
5. Fontana L, Partridge L. Promoting health and longevity through diet: from model organisms to humans. Cell. 2015;161(1):106-118. doi:10.1016/j.cell.2015.02.020
6. Cai D, Zhao S, Li D, et al. Nutrient Intake Is Associated with Longevity Characterization by Metabolites and Element Profiles of Healthy Centenarians. Nutrients. 2016;8(9):564. Published 2016 Sep 19. doi:10.3390/nu8090564
7. Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. Am J Cardiol. 1998;82(10B):18T-21T. doi:10.1016/s0002-9149(98)00718-8
8. Li Y, Wang K, Lv Y, et al. Vegetarian diet and likelihood of becoming centenarians in Chinese adults aged 80 y or older: a nested case-control study. Am J Clin Nutr. 2026;123(2):101136. doi:10.1016/j.ajcnut.2025.101136
9. Zeng Y, Feng Q, Hesketh T, Christensen K, Vaupel JW. Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study. Lancet. 2017;389(10079):1619-1629. doi:10.1016/S0140-6736(17)30548-2
10. Cuthbertson D, Smith K, Babraj J, et al. Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle. FASEB J. 2005;19(3):422-424. doi:10.1096/fj.04-2640fje
11. Zhang C, Zhang L, Zeng L, Wang Y, Chen L. Associations of serum albumin and dietary protein intake with all-cause mortality in community-dwelling older adults at risk of sarcopenia. Heliyon. 2024;10(8):e29734. Published 2024 Apr 16. doi:10.1016/j.heliyon.2024.e29734
12. Levine ME, Suarez JA, Brandhorst S, et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014;19(3):407-417. doi:10.1016/j.cmet.2014.02.006
13. Tong TYN, Appleby PN, Bradbury KE, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study. BMJ. 2019;366:l4897. Published 2019 Sep 4. doi:10.1136/bmj.l4897
14.  Chiu THT, Chang HR, Wang LY, Chang CC, Lin MN, Lin CL. Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan. Neurology. 2020;94(11):e1112-e1121. doi:10.1212/WNL.0000000000009093