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Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants.

Abstract

BACKGROUND AND PURPOSE

Blood pressure is an important risk factor for stroke, but the roles of serum total and HDL cholesterol, alpha-tocopherol, and beta-carotene are poorly established. We studied these factors in relation to stroke subtypes.

METHODS

Male smokers (n=28 519) aged 50 to 69 years without a history of stroke participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, a controlled trial to test the effect of alpha-tocopherol and beta-carotene supplementation on cancer. From 1985 to 1993, a total of 1057 men suffered from primary stroke: 85 had subarachnoid hemorrhage; 112, intracerebral hemorrhage; 807, cerebral infarction; and 53, unspecified stroke.

RESULTS

Systolic blood pressure > or = 160 mm Hg increased the risk of all stroke subtypes 2.5 to 4-fold. Serum total cholesterol was inversely associated with the risk of intracerebral hemorrhage, whereas the risk of cerebral infarction was raised at concentrations > or = 7.0 mmol/L. The risks of subarachnoid hemorrhage and cerebral infarction were lowered with serum HDL cholesterol levels > or = 0.85 mmol/L. Pretrial high serum alpha-tocopherol decreased the risk of intracerebral hemorrhage by half and cerebral infarction by one third, whereas high serum beta-carotene doubled the risk of subarachnoid hemorrhage and decreased that of cerebral infarction by one fifth.

CONCLUSIONS

The risk factor profiles of stroke subtypes differ, reflecting different etiopathology. Because reducing atherosclerotic diseases, including ischemic stroke, by lowering high serum cholesterol is one of the main targets in public health care, further studies are needed to distinguish subjects with risk of hemorrhagic stroke. The performance of antioxidants needs confirmation from clinical trials.

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  • Authors+Show Affiliations

    ,

    Department of Public Health, University of Helsinki, Finland. jaana.leppala@helsinki.fi

    , , ,

    Source

    Stroke 30:12 1999 Dec pg 2535-40

    MeSH

    Aged
    Blood Pressure
    Cerebral Infarction
    Cholesterol
    Cholesterol, HDL
    Controlled Clinical Trials as Topic
    Follow-Up Studies
    Humans
    Intracranial Hemorrhages
    Male
    Middle Aged
    Risk Factors
    Smoking
    Stroke
    Subarachnoid Hemorrhage
    Vitamin E
    beta Carotene

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    10582974

    Citation

    Leppälä, J M., et al. "Different Risk Factors for Different Stroke Subtypes: Association of Blood Pressure, Cholesterol, and Antioxidants." Stroke, vol. 30, no. 12, 1999, pp. 2535-40.
    Leppälä JM, Virtamo J, Fogelholm R, et al. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke. 1999;30(12):2535-40.
    Leppälä, J. M., Virtamo, J., Fogelholm, R., Albanes, D., & Heinonen, O. P. (1999). Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke, 30(12), pp. 2535-40.
    Leppälä JM, et al. Different Risk Factors for Different Stroke Subtypes: Association of Blood Pressure, Cholesterol, and Antioxidants. Stroke. 1999;30(12):2535-40. PubMed PMID: 10582974.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. AU - Leppälä,J M, AU - Virtamo,J, AU - Fogelholm,R, AU - Albanes,D, AU - Heinonen,O P, PY - 1999/12/3/pubmed PY - 1999/12/3/medline PY - 1999/12/3/entrez SP - 2535 EP - 40 JF - Stroke JO - Stroke VL - 30 IS - 12 N2 - BACKGROUND AND PURPOSE: Blood pressure is an important risk factor for stroke, but the roles of serum total and HDL cholesterol, alpha-tocopherol, and beta-carotene are poorly established. We studied these factors in relation to stroke subtypes. METHODS: Male smokers (n=28 519) aged 50 to 69 years without a history of stroke participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, a controlled trial to test the effect of alpha-tocopherol and beta-carotene supplementation on cancer. From 1985 to 1993, a total of 1057 men suffered from primary stroke: 85 had subarachnoid hemorrhage; 112, intracerebral hemorrhage; 807, cerebral infarction; and 53, unspecified stroke. RESULTS: Systolic blood pressure > or = 160 mm Hg increased the risk of all stroke subtypes 2.5 to 4-fold. Serum total cholesterol was inversely associated with the risk of intracerebral hemorrhage, whereas the risk of cerebral infarction was raised at concentrations > or = 7.0 mmol/L. The risks of subarachnoid hemorrhage and cerebral infarction were lowered with serum HDL cholesterol levels > or = 0.85 mmol/L. Pretrial high serum alpha-tocopherol decreased the risk of intracerebral hemorrhage by half and cerebral infarction by one third, whereas high serum beta-carotene doubled the risk of subarachnoid hemorrhage and decreased that of cerebral infarction by one fifth. CONCLUSIONS: The risk factor profiles of stroke subtypes differ, reflecting different etiopathology. Because reducing atherosclerotic diseases, including ischemic stroke, by lowering high serum cholesterol is one of the main targets in public health care, further studies are needed to distinguish subjects with risk of hemorrhagic stroke. The performance of antioxidants needs confirmation from clinical trials. SN - 0039-2499 UR - https://www.unboundmedicine.com/medline/citation/10582974/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=10582974 DB - PRIME DP - Unbound Medicine ER -