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Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers.

Abstract

Observational data suggest that diets rich in fruits and vegetables and with high serum levels of antioxidants are associated with decreased incidence and mortality of stroke. We studied the effects of alpha-tocopherol and beta-carotene supplementation. The incidence and mortality of stroke were examined in 28 519 male cigarette smokers aged 50 to 69 years without history of stroke who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study). The daily supplementation was 50 mg alpha-tocopherol, 20 mg beta-carotene, both, or placebo. The median follow-up was 6.0 years. A total of 1057 men suffered from incident stroke: 85 men had subarachnoid hemorrhage; 112, intracerebral hemorrhage; 807, cerebral infarction; and 53, unspecified stroke. Deaths due to stroke within 3 months numbered 38, 50, 65, and 7, respectively (total 160). alpha-Tocopherol supplementation increased the risk of subarachnoid hemorrhage 50% (95% CI -3% to 132%, P=0.07) but decreased that of cerebral infarction 14% (95% CI -25% to -1%, P=0.03), whereas beta-carotene supplementation increased the risk of intracerebral hemorrhage 62% (95% CI 10% to 136%, P=0.01). alpha-Tocopherol supplementation also increased the risk of fatal subarachnoid hemorrhage 181% (95% CI 37% to 479%, P=0.01). The overall net effects of either supplementation on the incidence and mortality from total stroke were nonsignificant. alpha-Tocopherol supplementation increases the risk of fatal hemorrhagic strokes but prevents cerebral infarction. The effects may be due to the antiplatelet actions of alpha-tocopherol. beta-Carotene supplementation increases the risk of intracerebral hemorrhage, but no obvious mechanism is available.

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  • Authors+Show Affiliations

    ,

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

    , , , , ,

    Source

    MeSH

    Aged
    Cerebral Hemorrhage
    Cerebral Infarction
    Double-Blind Method
    Humans
    Male
    Middle Aged
    Smoking
    Stroke
    Subarachnoid Hemorrhage
    Vitamin E
    beta Carotene

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    10634823

    Citation

    Leppälä, J M., et al. "Controlled Trial of Alpha-tocopherol and Beta-carotene Supplements On Stroke Incidence and Mortality in Male Smokers." Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 20, no. 1, 2000, pp. 230-5.
    Leppälä JM, Virtamo J, Fogelholm R, et al. Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers. Arterioscler Thromb Vasc Biol. 2000;20(1):230-5.
    Leppälä, J. M., Virtamo, J., Fogelholm, R., Huttunen, J. K., Albanes, D., Taylor, P. R., & Heinonen, O. P. (2000). Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers. Arteriosclerosis, Thrombosis, and Vascular Biology, 20(1), pp. 230-5.
    Leppälä JM, et al. Controlled Trial of Alpha-tocopherol and Beta-carotene Supplements On Stroke Incidence and Mortality in Male Smokers. Arterioscler Thromb Vasc Biol. 2000;20(1):230-5. PubMed PMID: 10634823.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers. AU - Leppälä,J M, AU - Virtamo,J, AU - Fogelholm,R, AU - Huttunen,J K, AU - Albanes,D, AU - Taylor,P R, AU - Heinonen,O P, PY - 2000/1/15/pubmed PY - 2000/1/15/medline PY - 2000/1/15/entrez SP - 230 EP - 5 JF - Arteriosclerosis, thrombosis, and vascular biology JO - Arterioscler. Thromb. Vasc. Biol. VL - 20 IS - 1 N2 - Observational data suggest that diets rich in fruits and vegetables and with high serum levels of antioxidants are associated with decreased incidence and mortality of stroke. We studied the effects of alpha-tocopherol and beta-carotene supplementation. The incidence and mortality of stroke were examined in 28 519 male cigarette smokers aged 50 to 69 years without history of stroke who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study). The daily supplementation was 50 mg alpha-tocopherol, 20 mg beta-carotene, both, or placebo. The median follow-up was 6.0 years. A total of 1057 men suffered from incident stroke: 85 men had subarachnoid hemorrhage; 112, intracerebral hemorrhage; 807, cerebral infarction; and 53, unspecified stroke. Deaths due to stroke within 3 months numbered 38, 50, 65, and 7, respectively (total 160). alpha-Tocopherol supplementation increased the risk of subarachnoid hemorrhage 50% (95% CI -3% to 132%, P=0.07) but decreased that of cerebral infarction 14% (95% CI -25% to -1%, P=0.03), whereas beta-carotene supplementation increased the risk of intracerebral hemorrhage 62% (95% CI 10% to 136%, P=0.01). alpha-Tocopherol supplementation also increased the risk of fatal subarachnoid hemorrhage 181% (95% CI 37% to 479%, P=0.01). The overall net effects of either supplementation on the incidence and mortality from total stroke were nonsignificant. alpha-Tocopherol supplementation increases the risk of fatal hemorrhagic strokes but prevents cerebral infarction. The effects may be due to the antiplatelet actions of alpha-tocopherol. beta-Carotene supplementation increases the risk of intracerebral hemorrhage, but no obvious mechanism is available. SN - 1079-5642 UR - https://www.unboundmedicine.com/medline/citation/10634823/Controlled_trial_of_alpha_tocopherol_and_beta_carotene_supplements_on_stroke_incidence_and_mortality_in_male_smokers_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=10634823.ui DB - PRIME DP - Unbound Medicine ER -