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People with atrial fibrillation are often given aspirin or anticoagulant medication to reduce blood clotting tendencies. Some natural inhibitors of blood clotting exist, such as garlic,17,18,19 fish oils,20 and vitamin E.21,22 However, even large amounts of fish oil are known to be less potent than aspirin,23 and whether any of these substances would be adequate substitutes for controlling the risk of stroke due to atrial fibrillation remains unknown. Anyone taking anticoagulant medication should advise their prescribing doctor before beginning to use any of these natural substances.
Elevated homocysteine levels in the blood have been linked to increased thickening of the carotid artery.24 Homocysteine can be lowered with folic acid, vitamin B6, or vitamin B12. (See the High Homocysteine section for more information.) However, whether lowering of elevated homocysteine helps prevent carotid stenosis or stroke is unknown.
Preliminary studies have found that people who eat foods high in antioxidants such as vitamin C and vitamin E have less risk carotid stenosis.25,26 In a double-blind study, people with atherosclerosis in the carotid arteries were given a palm oil extract containing 160–240 mg tocotrienols (a vitamin E-like supplement) and approximately 100–150 IU vitamin E per day. After 18 months, they had significantly less atherosclerosis or at least less progression of atherosclerosis compared to a group receiving placebo.27 Reducing carotid atherosclerosis should reduce the risk of suffering a stroke.
Evidence regarding the role of unsaturated fats (primarily found in vegetable oils, cooked and processed foods made with vegetable oils, nuts and seeds) is equally unclear,59,60,61 suggesting that unsaturated fats may have different effects on different types of stroke, or that some unsaturated fats differ from others in their influence on stroke risk. Similarly, the benefits of eating fish, which are high in omega-3 fatty acids, remain unknown. Fish consumption has been linked to reduced stroke risk in some,62,63 but not all64,65 studies.
Increasing dietary potassium has lowered blood pressure in humans, which by itself should reduce the risk of stroke;76 however, some of the protective effect of potassium appears to extend beyond its ability to lower blood pressure.77 Maintaining a high potassium intake is best achieved by eating fruits and vegetables. Avocados, potatoes, watermelon and soybeans are particularly high in potassium.
Those who have suffered a TIA are at high risk for suffering a stroke. As a result, they should also adopt lifestyle and dietary changes to lower their risk, as well as consult their medical doctor for possible drug treatment. People with a history of TIAs who took 400 IU of vitamin E per day with a small amount of aspirin had fewer attacks over the following two years than those who took only aspirin in a double-blind study.143
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8. Caicoya M, Rodriguez T, Corrales C, et al. Alcohol and stroke: a community case-control study in Asturias, Spain. J Clin Epidemiol 1999;52:677–84.
9. Hart CL, Smith GD, Hole DJ, et al. Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up. BMJ 1999;318:1725–1729.
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12. Ascherio A, Rimm EB, Hernan MA, et al. Relation of consumption of vitamin E, vitamin C, and carotenoids to risk for stroke among men in the United States. Ann Intern Med 1999;130:963–70.
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23. Heemskerk JW, Vossen RC, van Dam-Mieras MC. Polyunsaturated fatty acids and function of platelets and endothelial cells. Curr Opin Lipidol 1996;7:24–29 [review].
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27. Tomeo AC, Geller M, Watkins TR, et al. Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis. Lipids 1995;30:1179–83.
28. Stoy NS. Stroke and cholesterol: 'enigma variations'? J R Coll Physicians Lond 1997;31:521–26 [review].
29. Leppälä JM, Virtamo J, Fogelholm R, et al. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol , and antioxidants. Stroke 1999;30:2535-40.
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31. Iso H, Jacobs DR Jr, Wentworth D, et al. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med 1989;320:904-10.
32. Kagan A, Popper JS, Rhoads GG, Yano K. Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke 1985;16:390-6.
33. Yano K, Reed DM, MacLean CJ. Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke 1989;20:1460-5.
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37. Burchfiel CM, Curb JD, Rodriguez BL, et al. Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. Stroke 1994;25:951–7.
38. Rodriguez Artalejo F, Guallar-Castillon P, Banegas Banegas JR, et al. Consumption of fruit and wine and the decline in cerebrovascular disease mortality in Spain (1975-1993). Stroke 1998;29:1556–61.
39. Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 1997;26:1–13.
40. Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999;282:1233-9.
41. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998;98:1198–204.
42. Yang CY. Calcium and magnesium in drinking water and risk of death from cerebrovascular disease. Stroke 1998;29:411–414.
43. Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med 1987;316:235–40.
44. Simon JA, Hudes ES, Browner WS. Serum ascorbic acid and cardiovascular disease prevalence in U.S. adults. Epidemiology 1998;9:316–21.
45. Schmidt R, Fazekas F, Hayn M, et al. Risk factors for microangiopathy-related cerebral damage in the Austrian stroke prevention study. J Neurol Sci 1997;152:15–21.
46. Gale CR, Martyn CN, Winter PD, et al. Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people. BMJ 1995;310:1563–66.
47. Gey KF, Moser UK, Jordan P, et al. Increased risk of cardiovascular disease at suboptimal plasma concentrations of essential antioxidants: an epidemiological update with special attention to carotene and vitamin C. Am J Clin Nutr 1993;57:787S–797S [review].
48. Ascherio A, Rimm EB, Hernan MA, et al. Relation of consumption of vitamin E, vitamin C, and carotenoids to risk for stroke among men in the United States. Ann Intern Med 1999;130:963–70.
49. Daviglus ML, Orencia AJ, Dyer AR, et al. Dietary vitamin C, beta-carotene and 30-year risk of stroke: results from the Western Electric Study. Neuroepidemiology 1997;16:69–77.
50. Keli SO, Hertog MG, Feskens EJ, et al. Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study. Arch Intern Med 1996;156:637–42.
51. Yochum L, Kushi LH, Meyer K, et al. Dietary flavonoid intake and risk of cardiovascular disease in postmenopausal women. Am J Epidemiol 1999;149:943–9.
52. Keli SO, Hertog MG, Feskens EJ, et al. Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study. Arch Intern Med 1996;156:637–42.
53. Gillman MW, Cupples LA, Millen BE, et al. Inverse association of dietary fat with development of ischemic stroke in men. JAMA 1997;278:2145–50.
54. Seino F, Date C, Nakayama T, et al. Dietary lipids and incidence of cerebral infarction in a Japanese rural community. J Nutr Sci Vitaminol (Tokyo) 1997;43:83–99.
55. Brunner R. Dietary fat and ischemic stroke. JAMA 1998;279:1171–2 [letter].
56. Ornish D. Letter. JAMA 1998;279:1172.
57. Stein HD. Letter. JAMA 1998;279:1172.
58. Sasaki S, Zhang XH, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995;26:783–9.
59. Ricci S, Celani MG, Righetti E, et al. Fatty acid dietary intake and the risk of ischaemic stroke: a multicentre case-control study. UFA Study Group. J Neurol 1997;244:360–64.
60. Gillman MW, Cupples LA, Millen BE, et al. Inverse association of dietary fat with development of ischemic stroke in men. JAMA 1997;278:2145–50.
61. Seino F, Date C, Nakayama T, et al. Dietary lipids and incidence of cerebral infarction in a Japanese rural community. J Nutr Sci Vitaminol (Tokyo) 1997;43:83–99.
62. Zhang J, Sasaki S, Amano K, et al. Fish consumption and mortality from all causes, ischemic heart disease, and stroke: an ecological study. Prev Med 1999;28:520–29.
63. Keli SO, Feskens EJ, Kromhout D. Fish consumption and risk of stroke. The Zutphen Study. Stroke 1994;25:328–32.
64. Orencia AJ, Daviglus ML, Dyer AR, et al. Fish consumption and stroke in men. 30-year findings of the Chicago Western Electric Study. Stroke 1996;27:204–9.
65. Morris MC, Manson JE, Rosner B, et al. Fish consumption and cardiovascular disease in the physicians' health study: a prospective study. Am J Epidemiol 1995;142:166–75.
66. Sasaki S, Zhang XH, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995;26:783–9.
67. Tobian L. Dietary sodium chloride and potassium have effects on the pathophysiology of hypertension in humans and animals. Am J Clin Nutr 1997;65:606S–11S [review].
68. Perry IJ, Beevers DG. Salt intake and stroke: a possible direct effect. J Hum Hypertens 1992;6:23–5.
69. He J, Ogden LG, Vupputuri S, et al. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. JAMA 1999;282:2027-34.
70. Antonios TF, MacGregor GA. Salt intake: potential deleterious effects excluding blood pressure. J Hum Hypertens 1995;9:511–5 [review].
71. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998;98:1198–204.
72. Sasaki S, Zhang XH, Kesteloot H. Dietary sodium, potassium, saturated fat, alcohol, and stroke mortality. Stroke 1995;26:783–9.
73. Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med 1987;316:235–40.
74. Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation 1998;98:1198–204.
75. Yamori Y, Nara Y, Mizushima S, et al. Nutritional factors for stroke and major cardiovascular diseases: international epidemiological comparison of dietary prevention. Health Rep 1994;6:22–7.
76. Stamler J, Caggiula AW, Grandits GA. Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr 1997;65:338S–65S.
77. Suter PM. The effects of potassium, magnesium, calcium, and fiber on risk of stroke. Nutr Rev 1999;57:84–8.
78. Katerndahl DA, Realini JP, Cohen PA. Oral contraceptive use and cardiovascular disease: is the relationship real or due to study bias? J Fam Pract 1992;35:147–57 [review].
79. Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016–37 [review].
80. Scarabin PY, Alhenc-Gelas M, Plu-Bureau G, et al. Effects of oral and transdermal estrogen/progesterone regimens on blood coagulation and fibrinolysis in postmenopausal women. A randomized controlled trial. Arterioscler Thromb Vasc Biol 1997;17:3071–78.
81. Fung MM, Barrett-Connor E, Bettencourt RR. Hormone replacement therapy and stroke risk in older women. J Womens Health 1999;8:359–64.
82. Grodstein F, Stampfer MJ, Manson JE, et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med 1996;335:453–61.
83. Lewis MA. Myocardial infarction and stroke in young women: what is the impact of oral contraceptives? Am J Obstet Gynecol 1998;179:S68–77.
84. Thorogood M. Stroke and steroid hormonal contraception. Contraception 1998;57:157–67 [review].
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86. Mishell DR Jr. Cardiovascular risks: perception versus reality. Contraception 1999;59:21S–24S [review].
87. Zeitoun K, Carr BR. Is there an increased risk of stroke associated with oral contraceptives? Drug Saf 1999;20:467–73 [review].
88. Anonymous. Cardiovascular risk of oral contraceptives. Low, and mainly in women at risk. Prescrire Int 1998;7:118–24 [review].
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95. Paffenbarger RS Jr. Factors predisposing to fatal stroke in longshoremen. Prev Med 1972;1:522–8.
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105. Gorelick PB, Sacco RL, Smith DB, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 1999;281:1112–20 [review].
106. Elneihoum AM, Lindgarde F, Eriksson KF, et al. Calf pain in middle-aged individuals as a predictor of ischemic cerebrovascular disease. Angiology 1999;50:319–24.
107. Newman AB, Shemanski L, Manolio TA, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol 1999;19:538–45.
108. Shinton R. Lifelong exposures and the potential for stroke prevention: the contribution of cigarette smoking, exercise, and body fat. J Epidemiol Comm Health 1997;51:138–143.
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130. Gillum RF. Stroke in blacks. Stroke 1988;19:1–9.
131. Gillum RF. Stroke mortality in blacks: disturbing trends. Stroke 1999;30:1711–5.
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135. Sacco RL, Boden-Albala B, Gan R, et al. Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol 1998;147:259–68.
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139. Neaton JD, Wentworth DN, Cutler J, et al. Risk factors for death from different types of stroke. Multiple Risk Factor Intervention Trial Research Group. Ann Epidemiol 1993 ;3:493-9.
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