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Vitamin E and beta carotene supplementation in high risk for stroke: a subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.

Abstract

CONTEXT

High serum or dietary levels of vitamin E and beta carotene appear to be associated with lower risk of stroke, but studies regarding their supplementation have not supported their use in stroke prevention.

OBJECTIVE

To determine if vitamin E (dl-alpha tocopherol) and beta carotene supplementations could be used in prevention of stroke in men at high risk for hemorrhagic or ischemic events.

DESIGN

Population-based, randomized, double-blind, placebo-controlled, 2 x 2 factorial design trial (the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study), conducted from April 1985 through April 30, 1993, with median follow-up of 6 years.

INTERVENTIONS

Alpha tocopherol, 50 mg; beta carotene, 20 mg; both; or placebo.

PARTICIPANTS

From the total male population aged 50 through 69 years in southwestern Finland (n = 290,406), 29,133 male smokers were randomized to 1 of 4 treatment regimens. We excluded 614 men because of previous stroke at baseline, leaving 28, 519.

MAIN OUTCOME MEASURES

Incident and fatal subarachnoid and intracerebral hemorrhage, cerebral infarction, and unspecified stroke.

RESULTS

Stroke occurred in a total of 1057 men: 85 had subarachnoid and 112 had intracerebral hemorrhage, 807 had cerebral infarction, and 53 had unspecified stroke. Within 90 days from onset, 160 men died of stroke. Vitamin E supplementation increased the risk of subarachnoid hemorrhage (relative risk [RR], 2.45; 95% confidence interval [CI], 1.08-5.55) and decreased risk of cerebral infarction (RR, 0.70; 95% CI, 0.55-0.89) in hypertensive men but had no effect among normotensive men. Furthermore, it decreased the risk of cerebral infarction, without elevating the risk of subarachnoid hemorrhage, among hypertensive men with concurrent diabetes (RR, 0.33; 95% CI, 0.14-0.78). Beta carotene supplementation appeared to increase the risk of intracerebral hemorrhage and modestly decrease that of cerebral infarction among men with greater alcohol consumption.

CONCLUSION

Vitamin E supplementation may prevent ischemic stroke in high-risk hypertensive patients, but further studies are needed. Arch Neurol. 2000;57:1503-1509

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Public Health, University of Helsinki, PO Box 41, 00014 Helsinki, Finland. jleppala@ucla.edu.

    , , , ,

    Source

    Archives of neurology 57:10 2000 Oct pg 1503-9

    MeSH

    Dietary Supplements
    Double-Blind Method
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Risk Factors
    Stroke
    Treatment Outcome
    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

    11030804

    Citation

    Leppälä, J M., et al. "Vitamin E and Beta Carotene Supplementation in High Risk for Stroke: a Subgroup Analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study." Archives of Neurology, vol. 57, no. 10, 2000, pp. 1503-9.
    Leppälä JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke: a subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Arch Neurol. 2000;57(10):1503-9.
    Leppälä, J. M., Virtamo, J., Fogelholm, R., Albanes, D., Taylor, P. R., & Heinonen, O. P. (2000). Vitamin E and beta carotene supplementation in high risk for stroke: a subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Archives of Neurology, 57(10), pp. 1503-9.
    Leppälä JM, et al. Vitamin E and Beta Carotene Supplementation in High Risk for Stroke: a Subgroup Analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Arch Neurol. 2000;57(10):1503-9. PubMed PMID: 11030804.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vitamin E and beta carotene supplementation in high risk for stroke: a subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. AU - Leppälä,J M, AU - Virtamo,J, AU - Fogelholm,R, AU - Albanes,D, AU - Taylor,P R, AU - Heinonen,O P, PY - 2000/10/13/pubmed PY - 2001/2/28/medline PY - 2000/10/13/entrez SP - 1503 EP - 9 JF - Archives of neurology JO - Arch. Neurol. VL - 57 IS - 10 N2 - CONTEXT: High serum or dietary levels of vitamin E and beta carotene appear to be associated with lower risk of stroke, but studies regarding their supplementation have not supported their use in stroke prevention. OBJECTIVE: To determine if vitamin E (dl-alpha tocopherol) and beta carotene supplementations could be used in prevention of stroke in men at high risk for hemorrhagic or ischemic events. DESIGN: Population-based, randomized, double-blind, placebo-controlled, 2 x 2 factorial design trial (the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study), conducted from April 1985 through April 30, 1993, with median follow-up of 6 years. INTERVENTIONS: Alpha tocopherol, 50 mg; beta carotene, 20 mg; both; or placebo. PARTICIPANTS: From the total male population aged 50 through 69 years in southwestern Finland (n = 290,406), 29,133 male smokers were randomized to 1 of 4 treatment regimens. We excluded 614 men because of previous stroke at baseline, leaving 28, 519. MAIN OUTCOME MEASURES: Incident and fatal subarachnoid and intracerebral hemorrhage, cerebral infarction, and unspecified stroke. RESULTS: Stroke occurred in a total of 1057 men: 85 had subarachnoid and 112 had intracerebral hemorrhage, 807 had cerebral infarction, and 53 had unspecified stroke. Within 90 days from onset, 160 men died of stroke. Vitamin E supplementation increased the risk of subarachnoid hemorrhage (relative risk [RR], 2.45; 95% confidence interval [CI], 1.08-5.55) and decreased risk of cerebral infarction (RR, 0.70; 95% CI, 0.55-0.89) in hypertensive men but had no effect among normotensive men. Furthermore, it decreased the risk of cerebral infarction, without elevating the risk of subarachnoid hemorrhage, among hypertensive men with concurrent diabetes (RR, 0.33; 95% CI, 0.14-0.78). Beta carotene supplementation appeared to increase the risk of intracerebral hemorrhage and modestly decrease that of cerebral infarction among men with greater alcohol consumption. CONCLUSION: Vitamin E supplementation may prevent ischemic stroke in high-risk hypertensive patients, but further studies are needed. Arch Neurol. 2000;57:1503-1509 SN - 0003-9942 UR - https://www.unboundmedicine.com/medline/citation/11030804/Vitamin_E_and_beta_carotene_supplementation_in_high_risk_for_stroke:_a_subgroup_analysis_of_the_Alpha_Tocopherol_Beta_Carotene_Cancer_Prevention_Study_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/vol/57/pg/1503 DB - PRIME DP - Unbound Medicine ER -