Different Risk Factors for Different Stroke Subtypes

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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.