Antithrombotic and antihypertensive management 3 months after ischemic stroke : a prospective study in an inner city population.

Reference:Stroke 2000;31(2):469-75.

BACKGROUND AND PURPOSE: We sought to examine the frequency, predictors, and effects of
nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke.
METHODS: The population-based South London Community Stroke Register prospectively collected data on first-in-a-lifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event. 

RESULTS: In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254
(55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: OR=1. 60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS </=13: OR 2.08, 95% CI 1.18 to 3.66) and the Barthel Index (BI) score 5 days after the event (BI </=10: OR 1. 85, 95% CI 1.17 to 2.93). For antihypertensive therapies the stroke subtype (OR 2.46, 95% CI 1.33 to 4.54), GCS score (OR 2.97, 95% CI 1. 35 to 6.53), BI score (OR 2.33, 95% CI 1.27 to 4.29), and ethnicity (Caucasian: OR 2.43, 95% CI 1.15 to 5.14) were independently associated with nontreatment. Cox regression modeling showed no significant association between the treatment status and recurrence-free 3-year survival rates after controlling for severity and subtype of stroke.

CONCLUSIONS: Secondary prevention for a common disease such as stroke appears to be
inadequate in the study area. Healthcare professionals need to consider antithrombotic and
antihypertensive therapies for all stroke patients.

Eat to live, not live to eat.

Reference: Nutrition 2000;16(9):767-73.

Most of the prevailing chronic diseases in the world have an important nutritional component by
directly causing a specific disease, enhancing the risk through phenomena of promotion, exerting a
beneficial effect in decreasing risk, or preventing the disease. International studies in geographic
pathology have shown that a given disease may have vastly different incidence and mortality as a
function of residence. Laboratory research in animal models can reproduce fairly accurately what is
learned through international research and provide the basis for examining relevant hypotheses and, more importantly, proposed mechanisms of action. Validation of these approaches can be the basis for public-health recommendations and health-promotion activities. Through such techniques, it has been found that regular intake of foods with saturated fats such as meat and certain dairy products raise the risk of coronary heart disease. The total mixed-fat intake is associated with a higher incidence of the nutritionally linked cancers, specifically cancer of the postmenopausal breast, distal colon, prostate, pancreas. ovary, and endometrium. The associated genotoxic carcinogens for several of these cancers are heterocyclic amines, which also play a role in heart-disease causation, and these are produced during the broiling and frying of creatinine-containing foods such as meats.
Monounsaturated oils such as olive or canola oil are low-risk fats as shown in animal models and
through the observation that the incidence of specific diseases is lower in the Mediterranean region,
where such oils are customarily used. High salt intake is associated with high blood pressure and
with stomach cancer, especially with inadequate intake of potassium from fruits and vegetables and
of calcium from certain vegetables and low-fat dairy products. Vegetables, fruits, and soy products
are rich in antioxidants that are essential to lower disease risk stemming from reactive oxygen
systems in the body. Green and black teas are excellent sources of antioxidants of a polyphenol
nature. as is cocoa and some chocolates. Nutritional lifestyles that offer the possibility of a healthy
long life can be adopted by most populations in the world.

Vitamin E and Beta Carotene Supplementation in High Risk for Stroke: A Subgroup Analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.

Reference: Arch Neurol 2000;57(10):1503-9.

CONTEXT: High serum or dietary levels of vitamin E and beta carotene appear to be associated with lower risk of stroke, but studies regarding their supplementation have not supported their use in
stroke prevention. 

OBJECTIVE: To determine if vitamin E (dl-alpha tocopherol) and beta carotene
supplementations could be used in prevention of stroke in men at high risk for hemorrhagic or
ischemic events. 

DESIGN: Population-based, randomized, double-blind, placebo-controlled, 2 x 2 factorial design trial (the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study), conducted from April 1985 through April 30, 1993, with median follow-up of 6 years. 

INTERVENTIONS: Alpha tocopherol, 50 mg; beta carotene, 20 mg; both; or placebo. PARTICIPANTS: From the total male population aged 50 through 69 years in southwestern Finland (n = 290,406), 29,133 male smokers were randomized to 1 of 4 treatment regimens. We excluded 614 men because of previous stroke at baseline, leaving 28,519. 

MAIN OUTCOME MEASURES: Incident and fatal subarachnoid and intracerebral hemorrhage, cerebral infarction, and unspecified stroke. 

RESULTS: Stroke occurred in a total of 1057 men: 85 had subarachnoid and 112 had intracerebral hemorrhage, 807 had cerebral infarction, and 53 had unspecified stroke. Within 90 days from onset, 160 men died of stroke. Vitamin E supplementation increased the risk of subarachnoid hemorrhage (relative risk [RR], 2.45; 95% confidence interval [CI], 1.08-5.55) and decreased risk of cerebral infarction (RR, 0.70; 95% CI, 0.55-0.89) in hypertensive men but had no effect among normotensive men. Furthermore, it decreased the risk of cerebral infarction, without elevating the risk of subarachnoid hemorrhage, among hypertensive men with concurrent diabetes (RR, 0.33; 95% CI, 0.14-0.78). Beta carotene supplementation appeared to increase the risk of intracerebral hemorrhage and modestly decrease that of cerebral infarction among men with greater alcohol consumption. 

CONCLUSION: Vitamin E supplementation may prevent ischemic stroke in high-risk hypertensive patients, but further studies are needed.

Cilostazol Stroke Prevention Study: A Placebo-Controlled Double-Blind Trial for Secondary Prevention of Cerebral Infarction

Reference: Journal of Stroke and Cerebrovascular Diseases 2000;9(4):147-57.

ABSTRACT:

Cilostazol, an antiplatelet drug that increases the cyclic adenosine monophosphate (AMP) levels in platelets via inhibition of cyclic AMP phosphodiesterase, has been used in chronic arterial occlusive disease. The purpose of the present study was to examine the effects of cilostazol on the recurrence of cerebral infarction using a multicenter, randomized, placebo-controlled, double-blind clinical trial method. Patients who suffered from cerebral infarction at 1 to 6 months before the trial were enrolled between April 1992 and March 1996. Oral administration of cilostazol (100 mg twice daily) or placebo was randomly assigned to the patients and continued until February 1997. The primary endpoint was the recurrence of cerebral infarction. In total, 1,095 patients were enrolled. An analysis based on 1,052 eligible patients (526 given cilostazol and 526 given placebo) showed that the cilostazol treatment achieved a significant relative-risk reduction (41.7%; confidence interval, [CI], 9.2% to 62.5%) in the recurrence of cerebral infarction as compared with the placebo treatment (p=0.0150). Intention-to-treat analysis of 1,067 patients also showed a significant relative-risk reduction (42.3%; CI, 10.3% to 62.9%, p=0.0127). No clinically significant adverse drug reactions of cilostazol were encountered. Long-term administration of cilostazol was effective and safe in the secondary prevention of cerebral infarction.