Cited by 272Acute Ischemic Stroke ManagementCardiovascular Health and Risk FactorsLipoproteins and Cardiovascular Health

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Different Risk Factors for Different Stroke Subtypes: Association of Blood Pressure, Cholesterol, and Antioxidants

Leppälä, Jaana M., Virtamo, Jarmo, Fogelholm, Rainer, Albanes, Demetrius, Heinonen, Olli P.·1999·Stroke

DOI 10.1161/01.str.30.12.2535

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Abstract

Background and Purpose —Blood pressure is an important risk factor for stroke, but the roles of serum total and HDL cholesterol, α-tocopherol, and β-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 α-tocopherol and β-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 α-tocopherol decreased the risk of intracerebral hemorrhage by half and cerebral infarction by one third, whereas high serum β-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: Leppälä, J. M., Virtamo, J., Fogelholm, R., Albanes, D., & Heinonen, O. P.
Affiliations: 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.
University of Helsinki (FI)
ORCID: Albanes, Demetrius
Venue: Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1999-12
Volume: 30
Issue: 12
Pages: 2535-2540
ISSN: 0039-2499 (ISSN-L)
1524-4628
DOI: 10.1161/01.str.30.12.2535
OpenAlex: W2987377578
Cited by: 272
References: 41
Citations by year: 2026: 3 · 2025: 6 · 2024: 3 · 2023: 5 · 2022: 9 · 2021: 9 · 2020: 10 · 2019: 8 · 2018: 8 · 2017: 8 · 2016: 9 · 2015: 15 · 2014: 7 · 2013: 15 · 2012: 16
FWCI: 5.49
Type: journal article
Language: en
Open access: closed
Locations: Stroke (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01cn045165-030)
National Cancer Institute (N01 CN 45165)
Topics: Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Keywords: stroke subtypes, stroke risk factors, systolic blood pressure, total cholesterol, HDL cholesterol, alpha-tocopherol, beta-carotene, subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction, hemorrhagic stroke, ischemic stroke, antioxidants, ATBC Study
MeSH terms: Aged, Blood Pressure, Cerebral Infarction, Cholesterol, Follow-Up Studies, Humans, Cholesterol, HDL, Male, Middle Aged, Risk Factors, Smoking, Subarachnoid Hemorrhage, Vitamin E, Controlled Clinical Trials as Topic, beta Carotene, Intracranial Hemorrhages, Stroke

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Different Risk Factors for Different Stroke Subtypes: Association of Blood Pressure, Cholesterol, and Antioxidants

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