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Stroke, Vol 23, 607-610, Copyright © 1992 by American Heart Association

ARTICLES

Are hemostatic factors responsible for the paradoxical risk factors for coronary heart disease and stroke?

M Gliksman and A Wilson
Department of Community Medicine, University of Sydney, Australia.

BACKGROUND: The paradoxical occurrence of a high risk of stroke in some populations at low risk for coronary heart disease has long been known. Recently, evidence has appeared linking the paradoxical risk to population-based differences in diet, serum cholesterol, and alcohol intake. However, the pathophysiological mechanism of action that would explain this paradox is unlikely to be atherosclerosis alone. SUMMARY OF COMMENT: Several recent cross-sectional and prospective population studies have shown that hemostatic factors vary between populations in a manner consistent with the paradox. Studies have also shown that certain hemostatic factors are independent predictors of risk of coronary heart disease, ischemic stroke, and, probably, hemorrhagic stroke. CONCLUSIONS: Risk factors that enhance thrombosis and reduce fibrinolysis are capable of explaining the paradoxical occurrence of the incidence of coronary heart disease and stroke in certain populations.

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