Does vitamin E increase stroke risk?

Previous studies suggested taking vitamin E can protect the heart from coronary heart disease, but a BMJ study found that taking vitamin E could slightly increase the risk of haemorrhagic stroke - bleeding in the brain. Stroke is the third biggest cause of death in the UK

Researchers identified 9 studies with about 119,000 people randomised either to vitamin E or placebo on the outcome of stroke. They found that vitamin E increased the risk of haemorrhagic stroke by 22%, also found that vitamin E reduced the risk of ischaemic stroke by 10%. Given the small reduction in the risk of ischaemic stroke is exceeded by the incraese in the risk of haemorrhagic stroke, the researchers concluded that the widespread use of vitamin E should be avoided.

Critics say the findings are of small statistical significance, more research is needed to determine the level of Vitamin E that can become harmful. They "urge people to maintain a lifestyle of a balanced diet, regular exercise and monitoring their blood pressure to reduce their risk of a stroke."

Source: "Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials". BMJ 2010; 341:c5702 (Published 4 November 2010) free f/t.

Dabigatran vs warfarin - RE-LY trial

At the European Society of Cardiology (ESC) congress in August 2009, researchers reported that a potential thrombin inhibitor, dabigatran etexilate, was more effective than warfarin in reducing strokes and embolism events in people with atrial fibrillation (AF) – a form of irregular heartbeat. The NEJM also released a simultaneous online report of this new trial.

The authors said that warfarin treatment needs regular monitoring because it can cause bleeding and other complications and argued that there is a need for a new anticoagulant drugs that are safe, effective and convenient to use. Dabigatran is already licensed for use in people having hip and knee replacement surgery.

The study, known as the RE-LY trial, the Randomized Evaluation of Long-term Anticoagulation Therapy, recruited over 18,000 people with AF, average age of 71, from 44 countries and 951 centres, who had at least one other risk factor for stroke. People with severe heart valve disorder, condition that increased the risk of bleeding, liver disease, poor kidney or pregnant women were excluded.

Participants were randomly assigned to receive either 110 mg or 150 mg of dabigatran twice a day or warfarin treatment. Participants receiving dabigatran were blinded to what they were taking but those received warfarin were not. Participants were followed up for an average of 2 years.

The researchers found that those who took dabigatran reduced their risk of stroke and systemic embolism by 34%, also reduced risk of bleeding than warfarin. They concluded that the lower dose of dabigatran was as effective as warfarin for preventing stroke and embolism events, the higher dose was more effective than warfarin for preventing these events and there was no need for regular monitoring .

Critics noted that the higher dose of dabigatran was associated with higher risk of heart attack and had more gastric symptoms when compared to warfarin. More patients discontinued taking dabigatran than those with warfarin after 1 and 2 years of follow up due to serious adverse events. They also cautioned that the design that patients and physicians knew of the treatment allocation can bias the outcomes and that long term outcomes should be explored before the drug is licensed for people with AF.

In an accompanying editorial, the author said that dabigatran had greater risk of nonhemorrhagic side effects, “patients already taking warfarin with excellent INR control have little to gain by switching to dabigatran”, however other patients who have AF and at least one additional risk factor for stroke could benefit from it.

The study was funded by Boehringer Ingelheim, the manufacture of dabigatran. All outcome events were assessed by 2 independent investigators who were blinded to the treatment assigned to the participants.

Source: Connolly SJ, Ezekowitz MD, Yusuf S et al. "Dabigatran versus Warfarin in Patients with Atrial Fibrillation". NEJM 2009; 361(12):1139-1151

Online editorial - Gage B. "Can We Rely on RE-LY?". NEJM August 30, 2009

Beta blockers cost more lives than they saved

For many years, beta blockers have been given routinely to patients undergoing surgery to reduce the risk of heart attcks after operations, but a new study, published in The Lancet, of more than 8000 patients in 23 countries who had surgery has found that those given the drugs double their risk of stroke and a third more likely to die within a month of surgery, the BBC reported.

The lead researcher said although beta blockers had benefits in lowering heart attacks, they were outweighed bythe increase of stroke and death. The study claimed that about 800,000 would have died as a result of doctors giving out the drugs without considering the side effects.

Source: "POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial". Lancet 2008. DOI: 10.1016/S0140-6736(08) 60601-7. Ahead of print.

Owning a cat could cut stroke risks

Scientists at the International Stroke Conference in America said owning and stroking a cat may reduce stress and so protect against cardiovascular disease, reported The Telegraph.

They looked at nearly 4,500 adults aged 30 - 75 and found that cat owners had a much reduced chance of developing strokes or heart attacks, even those who no longer owned a cat benefited from these protective effects.

fast treatment of small strokes can prevent major ones

According to a research at Oxford University, fast assessment and treatment of minor strokes or transient ischemic attacks (TIA) can reduce the risk of early recurrent stroke by 80%. Early treatment could help prevent 100,000 strokes each year in Britain, but researchers said "the vast majority of patients in Britain have not been getting treatment for the first few weeks."

The study "Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison" was published in The Lancet (early online publication) October 9, 2007

Another study, "A transient ischemic attack clinic with round-the-clock-assess (SOS-TIA): feasibility and effects" published in The Lancet Neurology, also found that early treatment brought similar results in reducing the risk of a major stroke.

Middle aged women have more stroke than men

US researchers found that women aged 45 to 54 were more than twice as likely to have a stroke as men of the same age.

The National Stroke Association (US) poll found that many women could not recognise even one stroke symptom. The F.A.S.T. test helps women detect the stroke symptoms. Read more...

Folic acid supplements reduce stroke risk

A review in the June 2 issue of The Lancet shows that taking folic acid supplements reduces the risk of stroke by 18%. The findings also suggest that mandatory fortification of flour could reduce death rates from strokes.