Dietary Vitamin C, Beta-Carotene and 30-Year Risk of Stroke: Results from the Western Electric Study

Daviglus, Martha L.; Orencia, Anthony J.; Dyer, Alan R.; Liu, Kiang; Morris, Don M.; Persky, Victoria; Chávez, Noel; Goldberg, Jack; Drum, Melinda L.; Shekelle, Richard B.; Stamler, Jeremiah

doi:10.1159/000109673

Cited by 57 publications

(33 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 In 3 other cohort studies, 8,12,13 intake of ␤-carotene was unrelated to risk for stroke. Furthermore, in large-scale intervention trials ␤-carotene supplementation either had no effect on risk for stroke 29 or had no effect on the risk for cerebral infarction but increased risk for intracerebral hemorrhage.…”

Section: Hirvonen Et Al Antioxidant Intake and Stroke Risk In Male Smmentioning

confidence: 95%

“…Inverse associations with the risk for stroke have been observed for flavonols and flavones, 8 carotenoids, 9 and vitamin C. 10,11 In contrast, studies also exist in which no clear associations with dietary antioxidants were found. 12,13 One reason for the inconsistent results may be that these studies have examined only the associations with total stroke. Different subtypes of stroke, however, have different etiopathologies 14 and thus most likely also have different associations with dietary antioxidants.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers

Hirvonen

Virtamo

Korhonen

et al. 2000

Stroke

192

155

View full text Add to dashboard Cite

show abstract

Section: Hirvonen Et Al Antioxidant Intake and Stroke Risk In Male Smmentioning

confidence: 95%

mentioning

confidence: 99%

Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers

Hirvonen

Virtamo

Korhonen

et al. 2000

Stroke

192

155

View full text Add to dashboard Cite

show abstract

“…1,4 Some population studies have suggested that increased consumption of fruits and vegetables decreases the risk of atherosclerotic cardiovascular diseases (CVD), including cerebrovascular strokes, 5-9 whereas 1 study did not confirm this association. 10 These findings led to a great interest in the role of antioxidative vitamins in CVD, including cerebrovascular strokes.…”

mentioning

confidence: 99%

Plasma Vitamin C Modifies the Association Between Hypertension and Risk of Stroke

Kurl

Tuomainen

Laukkanen

et al. 2002

Stroke

View full text Add to dashboard Cite

Background and Purpose-There are no prospective studies to determine whether plasma vitamin C modifies the risk of stroke among hypertensive and overweight individuals. We sought to examine whether plasma vitamin C modifies the association between overweight and hypertension and the risk of stroke in middle-aged men from eastern Finland. Methods-We conducted a 10.4-year prospective population-based cohort study of 2419 randomly selected middle-aged men (42 to 60 years) with no history of stroke at baseline examination. A total of 120 men developed a stroke, of which 96 were ischemic and 24 hemorrhagic strokes. Results-Men with the lowest levels of plasma vitamin C (Ͻ28.4 mol/L, lowest quarter) had a 2.4-fold (95% CI, 1.4 to 4.3; Pϭ0.002) risk of any stroke compared with men with highest levels of plasma vitamin C (Ͼ64.96 mol/L, highest quarter) after adjustment for age and examination months. An additional adjustment for body mass index, systolic blood pressure, smoking, alcohol consumption, serum total cholesterol, diabetes, and exercise-induced myocardial ischemia attenuated the association marginally (relative risk, 2.1; 95% CI, 1.2 to 3.8; Pϭ0.01). Adjustment for prevalent coronary heart disease and atrial fibrillation did not attenuate the association any further. Furthermore, hypertensive men with the lowest vitamin C levels (Ͻ28.4 mol/L) had a 2.6-fold risk (95% CI, 1.52 to 4.48; PϽ0.001), and overweight men (Ն25 kg/m 2 ) with low plasma vitamin C had a 2.7-fold risk (95% CI, 1.48 to 4.90; Pϭ0.001) for any stroke after adjustment for age, examination months, and other risk factors. Conclusions-Low plasma vitamin C was associated with increased risk of stroke, especially among hypertensive and overweight men.

show abstract

“…H igh amounts of fruits and vegetables in the diet 1,2 as well as diets rich in antioxidant vitamins 3 have been associated with decreased incidence of stroke. A similar inverse relation has been observed between serum concentrations of antioxidant vitamins and the risk of fatal stroke.…”

mentioning

confidence: 99%

Controlled Trial of α-Tocopherol and β-Carotene Supplements on Stroke Incidence and Mortality in Male Smokers

Leppälä

Virtamo

Fogelholm

et al. 2000

ATVB

160

View full text Add to dashboard Cite

Abstract-Observational data suggest that diets rich in fruits and vegetables and with high serum levels of antioxidants are associated with decreased incidence and mortality of stroke. We studied the effects of ␣-tocopherol and ␤-carotene supplementation. The incidence and mortality of stroke were examined in 28 519 male cigarette smokers aged 50 to 69 years without history of stroke who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study). The daily supplementation was 50 mg ␣-tocopherol, 20 mg ␤-carotene, both, or placebo. The median follow-up was 6.0 years. A total of 1057 men suffered from incident stroke: 85 men had subarachnoid hemorrhage; 112, intracerebral hemorrhage; 807, cerebral infarction; and 53, unspecified stroke. Deaths due to stroke within 3 months numbered 38, 50, 65, and 7, respectively (total 160). ␣-Tocopherol supplementation increased the risk of subarachnoid hemorrhage 50% (95% CI Ϫ3% to 132%, Pϭ0.07) but decreased that of cerebral infarction 14% (95% CI Ϫ25% to Ϫ1%, Pϭ0.03), whereas ␤-carotene supplementation increased the risk of intracerebral hemorrhage 62% (95% CI 10% to 136%, Pϭ0.01). ␣-Tocopherol supplementation also increased the risk of fatal subarachnoid hemorrhage 181% (95% CI 37% to 479%, Pϭ0.01). The overall net effects of either supplementation on the incidence and mortality from total stroke were nonsignificant. ␣-Tocopherol supplementation increases the risk of fatal hemorrhagic strokes but prevents cerebral infarction. The effects may be due to the antiplatelet actions of ␣-tocopherol. ␤-Carotene supplementation increases the risk of intracerebral hemorrhage, but no obvious mechanism is available. Key Words: ␣-tocopherol Ⅲ ␤-carotene Ⅲ cerebral infarction Ⅲ intracerebral hemorrhage Ⅲ subarachnoid hemorrhage H igh amounts of fruits and vegetables in the diet 1,2 as well as diets rich in antioxidant vitamins 3 have been associated with decreased incidence of stroke. A similar inverse relation has been observed between serum concentrations of antioxidant vitamins and the risk of fatal stroke. 4,5 These findings suggest that the antioxidants may be effective in the primary prevention of stroke. However, associations shown by observational studies, particularly weak ones, must not be causal, because the elimination of both known and especially unknown confounders is difficult, if not impossible. These limitations are abolished in large controlled trials, such as the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study), 6,7 in which evaluation of the effects of ␣-tocopherol and ␤-carotene on cardiovascular diseases was incorporated into the study protocol. In the present study, we report the effects of these antioxidant vitamins on the incidence and mortality from hemorrhagic and ischemic strokes among the participants of the ATBC Study. MethodsThe ATBC Study was a randomized, double-blind, placebocontrolled, 2ϫ2 factorial design trial primarily testing the hypothesis that ␣-tocopherol and ␤-carotene supplements reduce the incid...

show abstract

Dietary Vitamin C, Beta-Carotene and 30-Year Risk of Stroke: Results from the Western Electric Study

Cited by 57 publications

References 26 publications

Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers

Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers

Plasma Vitamin C Modifies the Association Between Hypertension and Risk of Stroke

Controlled Trial of α-Tocopherol and β-Carotene Supplements on Stroke Incidence and Mortality in Male Smokers

Contact Info

Product

Resources

About