Eat fruits, yoghurt daily to reduce stroke risk

Different types of food are linked to risks of different types of stroke, say researchers, adding that higher intakes of fruit, vegetables and dairy products is linked to a lower risk of ischaemic stroke.

For the study, published in the European Heart Journal, the researchers picked over 4,18,000 people in nine European countries and investigated ischaemic stroke and haemorrhagic stroke separately.
The study found that while higher intakes of fruit, vegetables, fibre, milk, cheese or yoghurt were each linked to a lower risk of ischaemic stroke, there was no significant association with a lower risk of haemorrhagic stroke.

However, greater consumption of eggs was associated with a higher risk of haemorrhagic stroke, but not with ischaemic stroke, the researchers said.

"Our study also highlights the importance of examining stroke subtypes separately, as the dietary associations differ for ischaemic and haemorrhagic stroke, and is consistent with other evidence, which shows that other risk factors, such as cholesterol levels or obesity, also influence the two stroke subtypes differently," said study first author Tammy Tong from University of Oxford in the UK.

Ischaemic stroke occurs when a blood clot blocks an artery supplying blood to the brain or forms somewhere else in the body and travels to the brain where it blocks blood flow.

Haemorrhagic stroke occurs when there is bleeding in the brain that damages nearby cells. About 85 per cent of strokes are ischaemic and 15 per cent are haemorrhagic. Stroke is the second leading cause of deaths worldwide.

For the findings, the research team analysed data from 418,329 men and women in nine countries (Denmark, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the UK) who were recruited to the European Prospective Investigation into Cancer and Nutrition (EPIC) study between 1992 and 2000.

The participants completed questionnaires asking about diet, lifestyle, medical history and socio-demographic factors, and were followed up for an average of 12.7 years.

During this time, there were 4,281 cases of ischaemic stroke and 1,430 cases of haemorrhagic stroke.

The total amount of fibre (including fibre from fruit, vegetables, cereal, legumes, nuts and seeds) that people ate was associated with the greatest potential reduction in the risk of ischaemic stroke, the researchers said.

Every 10g more intake of fibre a day was associated with a 23 per cent lower risk, which is equivalent to around two fewer cases per 1,000 of the population over 10 years, they added.

Fruit and vegetables alone were associated with a 13 per cent lower risk for every 200g eaten a day, which is equivalent to one less case per 1,000 of the population over 10 years.

No foods were linked to a statistically significant higher risk of ischaemic stroke.

The researchers found that for every extra 20g of eggs consumed a day there was a 25 per cent higher risk of haemorrhagic stroke.

The researchers said the associations they found between different foods and ischaemic and haemorrhagic stroke might be explained partly by the effects on blood pressure and cholesterol.

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Take note, more so if you have been prescribed statins

People who take cholesterol-lowering statins may be at twice the risk of developing type 2 diabetes, says a new study. Statins are a class of drugs that can lower cholesterol and blood pressure, reducing the risk of heart attack and stroke. More than a quarter of middle-aged adults use a cholesterol-lowering drug, according to estimates.

The study found that statin users had more than double the risk of a diabetes diagnosis compared to those who didn’t take the drugs. Those who took the cholesterol-lowering drugs for more than two years had more than three times the risk of diabetes.

“The fact that increased duration of statin use was associated with an increased risk of diabetes — something we call a dose-dependent relationship — makes us think that this is likely a causal relationship,” said the study’s lead author.

“Statins are very effective in preventing heart attacks and strokes. I would never recommend that people stop taking the statin they have been prescribed based on this study, but it should open up further discussions about diabetes prevention,” he added.

For the study, the researchers included over 4,000 men and women who did not have diabetes, were candidates for statins based on heart disease risk and had not yet taken the drugs at the start of the study. About 16 per cent of the group — 755 patients — were eventually prescribed statins during the study period. 

Researchers also found that statin users were 6.5 percent more likely to have a troublingly high HbA1c value — a routine blood test for diabetes that estimates average blood sugar over several months. 

“Although statins have clear benefits in appropriate patients, scientists and clinicians should further explore the impact of statins on human metabolism, in particular the interaction between lipid and carbohydrate metabolism,” said co-author. 

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Cirrhosis Tied to Increased Stroke Risk

Patients with cirrhosis have a significantly increased risk of stroke, particularly hemorrhagic stroke, a retrospective cohort study of  some showed.

In a nationally representative sample of 1,618,059 patients, the incidence of stroke was 2.17% per year in patients with cirrhosis and 1.11% annually in patients without cirrhosis, according to researchers.

Although patients with cirrhosis had a higher risk of any kind of stroke (HR 1.4) than those without cirrhosis, the association between cirrhosis and stroke appeared to be much stronger for subarachnoid hemorrhage (HR 2.4) and intracerebral hemorrhage (HR 1.9) than for ischemic stroke (HR 1.3), the study authors reported online in a journal.

Similar associations were seen regardless of cirrhosis type in the 5% sample of Medicare inpatient and outpatient claims submitted from Jan. 1, 2008, through Dec. 31, 2014. However, the strongest association with stroke was seen in decompensated cirrhosis, lead researcher and colleagues said.

"Additional investigation into the epidemiology and pathophysiology of this association may yield opportunities for stroke risk reduction and prevention," they said, noting that their findings could potentially be explained by the mixed coagulopathy seen in cirrhosis. "The increased risk of ischemic and hemorrhagic stroke observed in our study may reflect these complex coagulation system aberrations, particularly for patients with more advanced, decompensated cirrhosis because these patients appeared to have a higher risk of all stroke types."

The study did not show any association between mild, non-cirrhotic liver disease and stroke.

These data "challenge the prevailing notion that cirrhosis is protective against stroke, an idea which can be traced to autopsy studies decades old," lead scientist said. "In the context of recent data demonstrating that patients with cirrhosis are not protected against venous thromboembolism, our results suggest that clinicians caring for patients with cirrhosis should perhaps remain vigilant of risk factors for both thrombotic and hemorrhagic complications," he wrote in an email.

In the 5% Medicare sample, 15,586 individuals (1.0%) had cirrhosis, with mean age 74.1. Just under half were women. During a mean followup of 4.3 years, 77,268 people in the sample were hospitalized with a stroke. These patients tended to be older, female, and had more risk factors for stroke, including hypertension, diabetes, coronary heart disease, chronic pulmonary disease and atrial fibrillation. The association between cirrhosis and thrombotic events was similar for both fatal and nonfatal stroke.

Mild liver disease was not associated with stroke (HR 0.8), ischemic stroke (HR 0.7), intracerebral hemorrhage (HR 1.1), or subarachnoid hemorrhage (HR 1.2).

Portal hypertensive hemorrhage in the gastrointestinal tract is commonly seen in patients with cirrhosis, the study authors noted, emphasizing that "these findings "support a hemorrhagic tendency in cirrhosis that is independent of portal hypertension. "On the other hand," they added, "a propensity for venous thromboembolism  in cirrhosis is increasingly recognized."

Although an earlier study of patients with non-alcohol-related cirrhosis reported that cirrhosis was associated with a lower risk of stroke, "important differences in study design and patient characteristics may explain our discrepant findings," they said.

Not only does cirrhosis not appear to be protective against stroke, but the disease may actually amplify underlying vascular risk factors, researchers stated. Compounding this, the risk factors for cirrhosis -- alcohol abuse, hepatitis C infection and metabolic disease -- may also increase stroke risk.
 
After performing a number of post sensitivity analyses and adjusting for additional comorbidities, the study results didn't change significantly, they reported. Similarly, brain imaging at the time of an outcome didn't change the results of the primary analysis.

Study limitations included use of a diagnosis code algorithm that prioritized positive predictive value over sensitivity in determining cirrhosis. For this reason, it's possible that some of the control patients had cirrhosis, the study authors noted.

Also, information about the duration of cirrhosis before inclusion in the cohort was not available so it couldn't be confirmed that all strokes were first-ever outcomes despite efforts to exclude patients with prior stroke. Finally, the cohort was made up of insurance beneficiaries and results may not be generalizable to younger patients.

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Manage diabetes well to prevent stroke risk

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 People suffering from diabetes need to keep their sugar levels in control to prevent strokes, say doctors, adding that diabetics are at double the risk of suffering a stroke than normal patients.

One basic precaution for diabetics to avoid stroke is to control weight.

"High abdominal fat leads to an increased production of bad cholesterol which saturates blood vessels. This blood gets deposited on the inside of blood vessels, leading to an increased risk of forming blood clots in the body causing stroke," said Dr Satnam Singh Chhabra, head (neuro and spine department) at Sir Ganga Ram Hospital in the capital.

According to Dr Singh, diabetics should also keep smoking at bay as it leads to further clogging of arteries by narrowing down the blood vessel leading to stroke.

 "Follow a heart-friendly diet at home. Diabetics can control cholesterol with a high intake of fibre-rich foods. There are several food items which are rich in fibre, including oats, whole-grain breads, peas and fruits," Singh added.


According to the World Congress of Cardiology, it is estimated that by 2020, heart diseases will be the cause of over 40 percent deaths in India as compared to 24 percent in 1990.

Among them, over 60 percent are estimated to be diabetics. In India, currently there are nearly 50 million diabetics.

"Diabetics should avoid fatty and fried food items as these lead to high cholesterol levels in the body," added Ashok Rai, senior consultant at Down Town Hospital in Guwahati, Assam.

3D MRI can spot stroke risk in diabetic patients

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 People with diabetes may be harbouring advanced vascular disease that could increase their risk of stroke, researchers warn.

The findings suggest that arterial imaging with 3D MRI could be useful in helping to determine stroke risk among diabetics.

The carotid arteries are vessels on each side of the neck that supply oxygenated blood to the head.

Narrowing of the carotid arteries is associated with risk of stroke but less is known about stroke risk in people with little or no narrowing of these arteries.

For the new study, the team used 3D MRI to study the carotid arteries for evidence of intraplaque hemorrhage (IPH), an indicator of advanced atherosclerotic disease.

"A recent analysis has shown that people with carotid artery narrowing and IPH have a five- to six-times higher risk of stroke in the near future compared to people without," explained study author Tishan Maraj, imaging analyst at Sunnybrook Research Institute in Toronto.

Dr. Maraj and colleagues focused their study on people with diabetes.

Of the 159 patients imaged, 37 (23.3 percent) had IPH in at least one carotid artery.

Five of the 37 patients had IPH in both carotid arteries.

IPH was found in the absence of carotid artery narrowing and was associated with an increased carotid artery wall volume as measured by 3D MRI.

"It was surprising that so many diabetic patients had this feature. So perhaps IPH is an early indicator of stroke risk that should be followed up," Dr Maraj added.

Although there is no treatment for IPH at this time, Dr Maraj said identification of it may help with risk stratification and could even have applications in the non-diabetic population.

"Even though you can't treat IPH, you can monitor patients a lot more closely," he concluded.

The new research will be presented next week at the annual meeting of the Radiological Society of North America (RSNA)
  

Eat fruits, vegetables to reduce stroke risk

Eating more fruits and vegetables may reduce stroke risk by almost a third, according to a fresh look at recent evidence. 

The results support existing recommendations from organizations like the U.S. Centers for Disease Control and Prevention (CDC), which already call for a diet rich in fresh greens. 

“The findings are consistent with the current knowledge that increasing consumption of fruits and vegetables should be encouraged to prevent stroke,” Dr. Yan Qu said in an email.
Qu, of the Qingdao Municipal Hospital and the Medical College of Qingdao University in Qingdao, China, led the analysis. 

A stroke occurs when bloodflow to part of the brain is blocked by a clot or a burst blood vessel. Without emergency care, a stroke can lead to severe brain damage or death. 

Stroke remains the fourth leading cause of death in the U.S., according to the CDC. 

Several studies have looked at the influence of diet on stroke risk. Some have tied eating lots of fruits and vegetables to lowered risk; others have found no link at all. 

The effect could be indirect, and eating fruits and vegetables may benefit overall health by reducing blood pressure, cholesterol, weight and other stroke risk factors, Qu said. It’s also possible that specific nutrients in the foods may reduce stroke risk, he said.
To get a better understanding of the relationship between stroke risk and plants in the diet, the researchers searched for reports from recent decades that tracked the eating habits and health of men and women around the world. 

Twenty studies examining a total of 16,981 strokes among 760,629 participants were included in the analysis. 

Overall, the people who ate the most fruits and vegetables were 21 percent less likely to have a stroke, compared to people who ate the lowest amounts, the researchers found. 

The benefits rose along with the amounts of produce consumed. Stroke risk fell by 32 percent for every 200 grams (g) per day of fruit people ate, and 11 percent with every 200 g of vegetables.
The researchers found that citrus fruits, leafy vegetables and apples and pears were the specific types of greenery linked to reduced stroke risk. 

“The effect of other types of fruit and vegetables on stroke risk still needs to be confirmed,” Qu said. 

The researchers cannot say for certain that eating fruits and vegetables caused fewer strokes among the participants. They point out that there could be other factors that influence the results; for example, people who eat more fruits and vegetables may lead generally healthier lives. 


"It doesn’t surprise me too much in that it seems to confirm what a lot of other studies have shown," Dr. David A. Miller said. 

Miller, who was not involved in the new study, directs the Advanced Primary Stroke Center at Mayo Clinic in Jacksonville, Florida.
"We still don’t know if there is anything inherent in the fruits and vegetables or whether it’s their effect on blood pressure," he said. "It’s a chicken and egg type of thing." 

Miller also pointed out that the researchers also found people who controlled their other risk factors - such as weight, smoking and overall diet - had the lowest risk of stroke. 

"Eating fruits and vegetables is helpful, but it’s not the only thing," he said.

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