Different risk factors for different stroke subtypes -: Association of blood pressure, cholesterol, and antioxidants
Different risk factors for different stroke subtypes -: Association of blood pressure, cholesterol, and antioxidants
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DOI：
10.1161/01.str.30.12.2535
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发表时间：
1999-12-01
期刊：
影响因子：
8.3
通讯作者：
Heinonen, OP
中科院分区：
文献类型：
--
作者：
Leppälä, JM;Virtamo, J;Heinonen, OP
背景和目的：血压是卒中的一个重要危险因素，但血清总胆固醇、高密度脂蛋白胆固醇、α-生育酚和β-胡萝卜素的作用尚不明确。我们研究了这些因素与中风亚型，方法男性吸烟者（n=28 519）年龄在50至69岁，没有中风史参加了α-生育酚，β-胡萝卜素癌症预防（ATBC）研究，对照试验，以测试α-生育酚和β-胡萝卜素补充剂对癌症的影响。从1985年至1993年，共有1057名男性患有原发性中风：85蛛网膜下腔出血; 112，脑内出血; 807，脑梗死;和53，未指明stroke. Results-Syphilis血压大于或等于160毫米汞柱的风险增加所有中风亚型的2.5至4倍。血清总胆固醇与脑出血的危险性呈负相关，而当血清总胆固醇浓度≥ 7.0mmol/L时，脑梗死的危险性升高;当血清高密度脂蛋白胆固醇浓度≥ 0.85mmol/L时，蛛网膜下腔出血和脑梗死的危险性降低。试验前高血清α-生育酚使脑出血的风险降低一半，脑梗死的风险降低三分之一，而高血清β-胡萝卜素使蛛网膜下腔出血的风险增加一倍，使脑梗死的风险降低五分之一。由于降低高血清胆固醇是公共卫生保健的主要目标之一，因此需要进一步研究来区分具有出血性卒中风险的受试者。抗氧化剂的性能需要临床试验的证实。
Background and Purpose-Blood pressure is an important risk factor for stroke, but the roles of serum total and HDL cholesterol, alpha-tocopherol, and beta-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 alpha-tocopherol and beta-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 greater than or equal to 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 greater than or equal to 7.0 mmol/L, The risks of subarachnoid hemorrhage and cerebral infarction were lowered with serum HDL cholesterol levels greater than or equal to 0.85 mmol/L. Pretrial high serum alpha-tocopherol decreased the risk of intracerebral hemorrhage by half and cerebral infarction by one third, whereas high serum beta-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.