(Stroke. 1999;30:2535.)
© 1999 American Heart Association, Inc.
Original Contributions |
Different Risk Factors for Different Stroke Subtypes
Association of Blood Pressure, Cholesterol, and Antioxidants
From the Department of Public Health, University of Helsinki (J.M.L., O.P.H.), the National Public Health Institute (J.V.), and the Department of Clinical Neurosciences, Helsinki University Central Hospital (R.F.), Helsinki, Finland, and the National Cancer Institute (D.A.), Bethesda, Md.
Background and Purpose—Blood
pressure is an important risk factor for stroke, but the roles of serum
total and HDL cholesterol, 
-tocopherol, and
ß-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 -tocopherol and ß-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 
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 7.0 mmol/L. The
risks of subarachnoid hemorrhage and cerebral
infarction were lowered with serum HDL cholesterol levels
0.85 mmol/L. Pretrial high serum -tocopherol
decreased the risk of intracerebral hemorrhage
by half and cerebral infarction by one third, whereas high serum
ß-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.
Key Words: antioxidants • blood pressure • cerebral infarction • cholesterol • intracerebral hemorrhage • subarachnoid hemorrhage
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