In case of a stroke, I plan to drink 2 cups of coffee, have 5 ounces of wine or a beer, and pop 3 melatonin 3 mg pills, then probably go to the hospital.  I would probably object to thrombotic therapy, although this is the great treatment of the neurologists.  It actually slightly increases your chances of dying.  The best strategy is probably to avoid getting a stroke in the first place.

To avoid a stroke, read how to avoid and treat high blood pressure.  Get your annual flu shot, have extra potassium in your diet (use "No-Salt"), eliminate salt, keep your weight down, exercise, take folate 800 mcg/d, vitamin B-12 500 mcg every other day, vitamin D 1000 IU/d, and magnesium 250 mg once or twice a day, eat your fruits and veggies, take care of your teeth, get your omega-3s (eat fish), eat whole grains and avoid regular pasta and white flour.  For anyone over age 50, taking 3-9 mg. of melatonin each night is very likely a good idea, although all the research on stroke to date is animal research.  All of this is part of my Recommendations for Healthy Living.  What's good for one part of your body is good for the rest of your body.

Genetics

PON1 Gene Polymorphism Incr Rish 4 fold Early Stroke: association between a genetic abnormality known as PON1 polymorphism with stroke in adults younger than age 45. PON1 stands for paraoxonase, an enzyme that helps HDL (good) cholesterol prevent the oxidation of LDL (bad) cholesterol. LDL oxidation promotes heart and blood vessel disease. JAHA 6/02.

IL-10 Lessens Stroke Progression: Study 231 stroke victims. Patients with low levels of IL-10 in their blood during the first hours after stroke were three times more likely to have worsening neurological symptoms. Stroke 2/27/03.

General

ACE Inhibitor Ramipril Cuts Stroke in Normopressure High Risk, Perinodopril Helps too: Angiotensin converting enzyme inhibitors block the activation of the renin-angiotensin system in the plasma as well as in the vascular wall; reduce proliferation of vascular smooth muscle; enhance endogenous fibrinolysis; have the potential to stabilise plaques; and decrease angiotensin II mediated atherosclerosis, plaque rupture, and vascular occlusion. 19 nation 9200 individuals 55yo+ with CVD, CAD, PVD(43%), or DM(38%) 4.5 yr f/u study found 61% decr fatal stroke (17 vs 44) and 31% decr stroke (156 vs. 226). Ramipril 2.5 to 10/d vs Vit E vs both vs placebo. 77% on ASA, 46% Rx HBP. Benefits for all groups including those with BP <120/70. Perindopril protection against recurrent stroke study (PROGRESS) recently reported that perindopril in combination with indapamide reduced the risk of recurrent strokes by 28% in patients with previous cerebrovascular disease.

Aggrenox Cuts Strokes, Not Death and $$$: aspirin-dipyridamole with ASA preventing formation of thromboxane A2 and dipyrid inhib uptake of adenosine and phosphodiestaerase inhib. Warfarin used if a-fib, heart value, or stroke while on antiplatelet rx. Two yr DB of 6602 pt at $88.50/mo head cost = $258,000/non-fatal stroke prevented. No diff in fatal strokes. Thus ASA 81mg/d is better due to much less costly.

Alcohol No Impact on Stroke; May Increase Brain Atrophy: MRIs to measure the brains of 1,909 men and women, age 55 and older. All were randomly selected from the Atherosclerosis Risk in Communities Study. Drinking habits either as never drank, former drinker, occasional drinker (less than one drink per week), low drinker (one to six drinks per week) or moderate drinker (seven to 14 drinks per week).  As alcohol consumption increased, the MRI detected increases in the ventricular and sulcal areas of the brain, which are spaces that do not contain brain tissue and an indication of brain atrophy. However, they found no consistent association between alcohol intake and the presence of infarctions or white matter lesions. After adjusting for factors such as smoking habits, body mass and income, the researchers found no reduction or protection in infarction associated with former drinkers or moderate drinkers. In addition, they did not find an association between alcohol intake and white matter lesions. Alcohol Intake and Cerebral Abnormalities on Magnetic Resonance Imaging in a Community-Based Population of Middle-aged Adults. Jingzhong Ding, et al. Stroke 12/5/03

Air Pollution Causes Stroke Increase: An analysis of stroke admission and air pollution data recorded in Kaohsiung, China, between 1997 and 2000 was done. During that period, 23,179 stroke admissions occurred. Air levels of particulate matter, NO2, SO2, CO, and O3 were measured. Particulate matter and NO2 were the most important pollutants. For each incremental increase in air levels of particulate matter and NO2, the risk of admission for intracerebral hemorrhage or ischemic stroke rose by around 50%. After accounting for these pollutants, the effects of the other pollutants on admission rates were usually not significant. Stroke 2003;34. 10/10/03.

Aspirin as Good as Warfarin: NEJM study 11/15/01 of 2206 patients recovering from a first stroke found that 18% of those on warfarin vs 16% of those assigned randomly to aspirin died or suffered another stroke in the next 2 years. Warfarin still better if clots came from inside heart.

Antibiotic Use Lowers Stroke Risk: Paul Brassard, Royal Victoria Hospital in Montreal. 1,888 stroke patients and 9,440 controls. Antibiotics within the previous year were about 20 percent less likely to have a stroke. Penicillins, such as amoxicillin and ampicillin, had the most pronounced effect. Current penicillin users were 47 percent less likely to experience a stroke. Stroke 8/8/03

Bacterial Infections Increase Carotid Plaque: Prospective 5 yr study of 826 adults with carotid studies at baseline. Those with chronic infections including lungs, urinary tract and teeth were 2.86 times more likely to show an increase in carotid arteriosclerosis over the five years. 268 with chr infections, esp smokers, drinkers, and elderly. Viral infections not important. J Amer Heart Assoc 2/27/01.

Caffeine-Alcohol Within 3 Hr Helps Stroke: In a 23-patient University of Texax study with drugs equal to 2 cups coffee (8 mg/kg) and two alcoholic drinks (0.4g/kg). researchers found decreased stroke damage by 80%. Stroke 4/03 Paisith Piriyawat, W. Scott Burgin, et al.

Rofecoxib (Vioxx) Increased Thrombotic Events: In a planned 3-year DB PC study of the effect of rofecoxib on the risk of recurrent neoplastic polyps of the large bowel in 2,586 patients with a history of colorectal adenomas, 46 patients in the rofecoxib group had a confirmed thrombotic event during 3,059 patient-years of follow-up, as compared with 26 patients in the placebo group during 3,327 patient-years of follow-up, a 92% increase with rofecoxib; P=0.008). Overall and cardiovascular mortality was similar in the two groups. Conclusions Among patients with a history of colorectal adenomas, the use of rofecoxib was associated with an increased cardiovascular risk. Cardiovascular Events Associated with Rofecoxib in a Colorectal Adenoma Chemoprevention Trial. Bresalier RS, Sandler RS, et al. N Engl J Med. 2005 March 17. Ed: As everyone knows, Vioxx was pulled from the market shortly after this study.

Celecoxib (Celebrex) Increased Death, Heart Attacks, Strokes, and Heart Failure: In a 3-year DB PC study of 2035 patients with a history of colorectal neoplasia given celecoxib (200 mg or 400 mg twice daily) with placebo for the prevention of colorectal adenomas, a composite cardiovascular end point of death from cardiovascular causes, myocardial infarction, stroke, or heart failure was reached in 7 of 679 patients in the placebo group (1.0 percent), as compared with 16 of 685 patients receiving 200 mg of celecoxib twice daily (130% increase)(2.3%; HR = 2.3) and with 23 of 671 patients receiving 400 mg of celecoxib twice daily (240% increase)(3.4%; HR = 3.4). Celecoxib use was associated with a dose-related increase in the composite end point of death from cardiovascular causes, myocardial infarction, stroke, or heart failure. Cardiovascular Risk Associated with Celecoxib in a Clinical Trial for Colorectal Adenoma Prevention. Solomon SD, McMurray JJ, et al. N Engl J Med. 2005 March 17. Ed: Eventhough Celebrex appears to have done worse than Vioxx, it has not ben removed from the market.

Citicoline Said to be of Some Benefit After Stroke: A meta-analysis of four studies giving oral citicoline 500, 1000, or 2000 mg/d started within 24 hours of stroke onset to 1372 stroke patients in double-blind studies reports that after three months 25% recovered vs. 20% with placebo.  In at least one study, the citicoline was continued for six weeks (Neurology. 2001 Nov 13;57(9):1595-602).  Only one of the four studies reported finding significant results, but the meta-analysis was able to report significant benefit by pooling the data which makes small benefits more likely to be statistically significant.  The best effect was with the 2000 mg dosage where 28% citicoline patients had recovered by three months. University Hospital, Girona, Spain. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Davalos A, Castillo J, et al. Stroke. 2002 Dec;33(12):2850-7

Estradiol Increase Increases Stroke Risk Some: In a 6-year follow-up study of 2,197 men ages 71-93 in the Honolulu-Asia Aging Study free of stroke, coronary heart disease, and cancer, 124 men developed a stroke. After age adjustment, men in the top quintile of serum estradiol experienced a twofold excess risk of stroke vs men whose estradiol levels were lower (14.8 vs 7.3/1,000 person-years, p < 0.001). Among the lower quintiles, there were little differences in the risk of stroke. After additional adjustment for hypertension, diabetes, adiposity, cholesterol concentrations, atrial fibrillation, and other characteristics, men in the top quintile of serum estradiol continued to have a higher risk of stroke vs those whose estradiol levels were lower (relative hazards = 2.2; p < 0.001). Testosterone was not related to the risk of stroke. Serum estradiol and risk of stroke in elderly men. Abbott RD, et al. University of Virginia. . Neurol 2007 Feb 20;68(8):563-8.

Exercise Decreases Stroke: J Am Coll Cardiol 2002 May 1;39(9):1482-8. Benefit especially for those with increased L ventricular heart mass, but present in all.

Exercise: Fit Men Much Lower Stroke Risk: 16,878 men, ages 40-87 yr, maximal treadmill exercise test, self-reported health habits. 32 stroke deaths during 10 yr of follow-up. After adjustment for age and examination year, there was an inverse association between cardiorespiratory fitness and stroke mortality (P = 0.005 for trend). This association remained after further adjustment for cigarette smoking, alcohol intake, body mass index, hypertension, diabetes mellitus, and parental history of coronary heart disease (P = 0.02 for trend). High-fit men (most fit 40%) had 68% and moderate-fit men had 63% lower risk of stroke mortality when compared with low-fit men (least fit 20%), respectively. Aerobics Center Longitudinal study. Tx A&M. Med Sci Sports Exerc 2002 Apr;34(4):592-5

Fats: Decreased with Fat, Monounsat, and Sat Fat: Harvd study JAMA 12/24/97

Fats: Sat Fats Good, Trans Fats & HBP Bad for Intraparenchymal Stroke: Harvard 85000 nurses study found risk of intraparenchymal hemorrhage higher in women in lowest quintile of sat fats. RR 2.36. For trans unsat fat the RR was 2.50. Animal protein was protective with RR 0.32. Excess risk for low sat fats primarily in women with HBP. RR 3.66. However, HBP no influence on transfats effect or animal protein effect. Circulation. 2001 Feb 13;103(6):784-6

Fats, Mammal Meat No Impact: Harvard. 42,732 men 40yo+ 14 yr f/u. No different with trans-fats or polyunsat, or mono-unsat, or cholesterol. Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. Ka He, research associate, Anwar Merchant, research associate, Eric B Rimm, associate professor, Bernard A Rosner, professor, Meir J Stampfer, professor, Walter C Willett, professor, Alberto Ascherio. BMJ 2003;327:777-782

Flu Shot Cuts Strokes & Heart Deaths: Study of 148,000 65yo+ in health care system. Vaccination against influenza was associated with a reduction in the risk of hospitalization for cardiac disease (reduction of 19 percent during both seasons [P<0.001]), cerebrovascular disease (reduction of 20% during the two seasons, and pneumonia or influenza (reduction of 30% during the two seasons and a reduction in the risk of death from all causes (reduction of 49% during the two seasons. U Minn. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003 Apr 3;348(14):1322-32Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M.

Folate 2-5mg & Similar Amount B-12 Recommended: Alzheimers up 300%, Stroke 500%, Vascular Dementia 500% in upper quartile of normal range of homocysteine in case controlled study of 280 patients. Recommendation only speculative and by Tel Aviv researcher Gorzcyn on Science Daily 10/4/02. McIlroy,U Belfast, J Amer Heart Assoc 10/02.

Folate Helps: 9,764 US men and women aged 25 to 74 years who participated in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up. In 19 years of follow-up, 926 incident stroke events and 3758 incident CVD events were documented. The relative risk (RR) was 0.79 (P=0.03) for incident stroke events and 0.86 (P<0.001) for incident CVD events in the highest quartile of dietary folate intake (median, 405.0 microg/day) compared with those in the lowest quartile (median, 99.0 microg/day), after adjustment for established cardiovascular risk factors and dietary factors. Stroke 2002 May;33(5):1183-9

B-6, B-12, Folate Not Help Stroke, Heart: In a 2 year DB PC study of 3068 stroke victims given high dose (25 mg, 0.4 mg, 2.5 mg respectively) or low dose (0.2 mg, 0.006 mg, 0.02 mg), there was no difference what so ever in strokes, heart attacks, or death during follow-up although there was a moderate decrease (2 micromol/L) in homocysteine. The study did find a more major decrease (3 micromol/L) in homocysteine was linked to decrease health risks. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, Sides EG, Wang CH, Stampfer M. JAMA. 2004 Feb 4;291(5):565-75

Folic Acid Supplementation Prevents Strokes: In a study from Northwestern University, 43 732 men, aged 40 to 75 years, who were free of cardiovascular diseases and diabetes were followed for 14 years. There were 725 strokes, 455 ischemic, 125 hemorrhagic, and 145 unknown types. After adjustment for lifestyle and dietary factors, intake of folate was associated with a 30% lower risk of ischemic stroke. The multivariate relative risk of ischemic stroke was 0.71 (P=0.05) for men in the highest quintile of intake compared with the lowest quintile. Intake of vitamin B₁₂, but not B₆, was also inversely associated with risk of ischemic stroke. B₆, and B₁₂ was vitamin supplements. Vitamin B₁₂ intake was also inversely associated with ischemic but not hemorrhagic stroke. Comparing men in the highest quintile of vitamin B₁₂ intake with those in the lowest, the multivariate RR was 0.73. Folate, Vitamin B₆, and B₁₂ Intakes in Relation to Risk of Stroke Among Men. Ka He, Anwar Merchant, Eric B. Rimm, Bernard A. Rosner, Meir J. Stampfer, Walter C. Willett, Alberto Ascherio. Stroke. 1/2004;35:169

Folic Acid, B-6, and B-12 Fail to Prevent in DB: In a 3680 persons who had already had one non-disabling stroke were studied in a DB PC study for 3.7 years at 54 centers. High doses of the three vitamins lowered homocysteine by 8% but failed to reduce the frequency of stroke. James Toole, Wake Forest, JAMA 2/3/04.

Fruits & Veggies Help: 480,000 ischemic strokes per year. Harvard Nurses and Health Prof studies studied. Each serving of fruits and veg reduced stroke risk by 3% in women and 5% in men. JAMA 10/6/99. Most protection from crucifers broccoli, cabbage, cauliflower, and green leafy gets; and vitamin C foods such as citrus and juices. Flavonoid, folate, potassium, vit C may all be playing a role. US average consumption 4.4 servings per day. Willett, W.C. JAMA. 1999, Oct 6, v282, n13, p1233-1239.

Gum Disease: 303 ischemic stroke and TIA patients compared to 300 population controls, and 168 hospital controls with non-vascular and non-inflammatory neurological diseases found that after adjustment for age, sex, number of teeth, and other factors, the risk of cerebral ischemia increased with increasing severity of periodontitis. Subjects with severe periodontitis had a 4.3-fold increased risk of cerebral ischemia than those with mild or no periodontitis. Men, but not women, were the ones affected. Gingivitis and periodontitis are treatable and preventable conditions. Armin J. Grau, University of Heidelberg. Stroke 2004;35:496-501.

Gum Disease May Increase Strokes: State University of New York at Buffalo are saying after finding people who suffer from severe gum disease face twice the risk of an ischemic stroke. 10,000 people -- age 25 to 75 -- who took part in the first National Health and Nutrition Examination Survey from 1972 to 1974, and its successor, which concluded in 1992. Oct. 9, Arch Intern Med

Gum Disease, Tooth Loss Factors: Harvard male Health Professionals Study 41,000+ men. 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. <25 teeth HR 1.57 for stroke. recent tooth loss no more important. Periodontal disease more modest association HR 1.33. Periodontal disease, tooth loss, and incidence of ischemic stroke. Joshipura KJ, Hung HC, Rimm EB, Willett WC, Ascherio A. Stroke 2003 Jan;34(1):47-52

HBP: BP Not Improving in U.S.: Framingham study found that an increase of BP from age 30 to age 65 of 20 mmHg systolic and 10 mmHg diastolic was the norm. Nationally, blood pressure control has shown no improvement over last 40 years despite improved detection and treatment. Author says we need weight loss, decreased salt, and decreased alcohol consumption. JAMA ’96;275:1571. Nationally, weight has increased considerably over the last 40 years.

HBP Most Important in Mortality: Shanghai study 18,000 45-59-year-olds found a hypertension history caused a high mortality rate with an RR 4.5 for the highest group. Alcohol was important only at an extreme level. Educational level had strong inverse effect. There was no association with dietary vitamin C, E, carotene, or riboflavin. Circ ’97;96:50

H. Pylori CaG High in Ischemic Atherosclerotic Stroke: Prevalence of H. pylori infection among patients with large-vessel stroke, cardioembolic stroke, and normal controls was about the same. However, the presence of CagA-positive strains was significantly higher in large-vessel stroke patients than the cardioembolic stroke group — 42.8% vs 19.7%. It was also higher than those of the controls — 17.9%. CagA+ had highest CRP. Circ 7/02

Inositin IM Helps Rats Recover from Stroke: Harvard, Proceedings of the National Academy of Sciences 6/25/02. Helps stimulate new growth of nerve cells. Benowitz

Melatonin Neuroprotective for Ischaemic Stroke s: In a meta-analysis of fourteen studies involving 432 animals, melatonin improved the outcome by an average of 43%. Systematic review and meta-analysis of the efficacy of melatonin in experimental stroke. Macleod MR, et al. National Stroke Research Institute, Melbourne, Australia. J Pineal Res. 2005 Jan;38(1):35-41

Melatonin: Helped Injured Nerve: Beneficial effects of melatonin on reperfusion injury in rat sciatic nerve. Sayan H, et al. J Pineal Res. 2004 Oct;37(3):143-8 

Melatonin: Stroke Model Helped: Pretreatment with melatonin exerts anti-inflammatory effects against ischemia/reperfusion injury in a rat middle cerebral artery occlusion stroke model. Pei Z, et al. J Pineal Res. 2004 Sep;37(2):85-91.

Melatonin: Delayed Melatonin Reduced Infarct Size: In rats given experimental strokes with 1.5 hour interruption of blood flow, melatonin 72 hours after the stroke was still beneficial in minimizes the stroke damage by 35%. Lee EJ, et al. National Cheng Kung University, Taiwan. J Pineal Res. 2004 Jan;36(1):33-42

Melatonin: Brain Edema Helped with Reduced Infarct Size:  Brain edema was produced in rats by creating a lesion via cortical freezing. Melatonin was administered (50 mg/kg intraperitoneally) 15 minutes after the cold injury was induced. In 24 hours, melatonin reduced edema (86% for placebo versus 80% for melatonin, P < 0.001) and blood-brain barrier permeability (45.34% in the control versus 38.26% with melatonin, P < 0.001) at the periphery of cold injury. Area of infarct reduced from 5.8% in the control group to 3.3% in the melatonin treatment group (P < 0.001). Gorgulu A et al. Univ Trakya, Turkey. Neurosurgery. 2001 Dec;49(6):1434-41

Nortriptyline or Fluoxetine Help Stroke Victims Live Longer: Poststroke depression increases mortality for more than 5 years after the stroke. In a 12-week DB PC study with 9 years of follow-up for 104 stroke patients treated with nortriptyline, fluoxetine, or placebo early in the recovery period after a stroke, 48%) had died by the time of the 9-year follow-up. Of 53 patients who were given full-dose antidepressants, 68% were alive at follow-up, compared with only 36% of placebo-treated patients, a significant difference. The beneficial effect of antidepressants remained significant both in patients who were depressed and in those who were nondepressed at enrollment, after the effects of other factors associated with mortality (i.e., age, coexisting diabetes mellitus, and chronic relapsing depression) were controlled. There were no intergroup differences in severity of stroke, impairment in cognitive functioning and activities of daily living impairment, and other medications received. Mortality and poststroke depression: a placebo-controlled trial of antidepressants. Jorge RE, et al. University of Iowa. Am J Psychiatry. 2003 Oct;160(10):1823-9.

Omega-3 Good: Fewer Strokes: ’95 UCSF study in Stroke compared serum fatty acids in 96 men with CVA and 96 without. For each 0.13% incr alpha-linolenic, stroke risk dropped 37%. Higher phospholipid stearic acid (18:0) assoc with 37% increase for one standard deviation. Cigarettes and BP other risk factors detected in study. Joel A. Simon. Stroke ’95;26:778-82

Omega-3 Good: Fish Consumption Fewer Strokes: 12 yr f/u in the NHANES I epidemiol study found the RR for white women eating fish more than once a week was .55, for white men .85, and for blacks .51. Gillem, CDC, Arch Intern Med 3/96;11:156

Omega-3 Bad: Slightly more Strokes with Fish: The Chicago Western Electric Study found that men with the highest fish intake (>35g/d) had a risk factor of RR=1.34, (<35 but >18) RR=.96, (<18 but >0)=RR 1.00 Stroke 2/96;27:204

Omega-3 Bad: Fish Increase Stroke: risk of stroke increased with the consumption of fish, p = 0.04. Those in the highest quintile of consumption (46 g of fish/day) had a multivariate adjusted odds ratio (OR) of 1.95 as compared to those in the lowest quintile (11 g/ day). The risk of cerebral infarction also increased with the consumption of fish, showing an OR of 1.98. Those in the highest quintile of n-3 fatty acid consumption (660 mg/day) were at borderline higher risk of stroke, with an OR of 1.76, and also of cerebral infarction (OR: 1.89), as compared to those in the lower quintile of n-3 fatty acids consumption (115 mg/day). Neuroepidemiology 2002 May-Jun;21(3):107-14

Omega-3 Good: Fewer Strokes with Fish in Zutphen Study: Dutch men consuming over 20g/wk of fish had RR 0.49 in long f/u study of 556 men. Keli, Stroke 2/94;25:328; Same in Perth case control study of 536 stroke victims vs controls showing fish over twice/month protective. Stroke 1/94.

Omega-3 Good: Fewer Strokes in Spain Linked to Fish, Fruit, and Less Wine: 55% decrease in recent years. Analysis by province. Fruit incr and wine decr were significant. Rodriguez, Stroke 8/98;29:1556

Omega-3 Bad: More Strokes in Greenland: When compared to Denmark, where fish consumption is not as high, Greenlanders do have more strokes. An autopsy study in Greenland has also found higher levels of n-3 PUFAs in adipose tissue of those dying of stroke. The rate of stroke also decreased in Japan from 1950-80 with decreases in fish consumption, although other factors may well have also occurred. Thus, very high levels of sea food consumption may be a risk factor for stroke. Pedersen, Lancet 353:812-3 3/6/99. Ed: However, no study has looked at the amount of salt consumption, which may vary in parallel with fish if salted fish consumption is high.

Potassium helps: Diet high in potassium assoc with 38% lower CVA than diets lowest in K in Harvd study 50000 Health Prof f/u Study. High K=citrus, banana, spinach, tomato, & dairy. Alberto Ascherio, Circ 1/99.

Potassium Cuts Strokes: low potassium diet at baseline (<34.6 mmol potassium per day) experienced a 28% higher hazard of stroke (hazard ratio 1.28, 95% CI 1.11 to 1.47; P<0.001) than other participants, after adjustment for established cardiovascular disease risk factors. NHANES I 19 yr f/u 9800 adults. Stroke 2001 Jul;32(7):1473-80

Stroke Recurrence: Reducing BP After Stroke No Impact On Silent Brain Infarct or Atrophy: In a DB PC study of 667 patients, the angiotensin-converting enzyme (ACE) inhibitor perindopril (4 mg daily), with or without the diuretic indapamide (2 mg daily) over 3.9 years reduced the blood pressure (systolic/diastolic) by 5.2/2.6 mmHg but had no effect on recurrent symptomatic stroke or new SBI. The baseline diastolic blood pressure was significantly associated with the risk of new SBI (p = 0.004). Effects of perindopril-based blood pressure lowering and of patient characteristics on the progression of silent brain infarct: the Perindopril Protection against Recurrent Stroke Study (PROGRESS) CT Substudy in Japan. Hasegawa Y, Yamaguchi T, Omae T, Woodward M, Chalmers J; PROGRESS CT Substudy Investigators. Japan. Hypertens Res. 2004 Mar;27(3):147-56

Sudden Jolts Increase: 22% of strokes occur after sudden startle-type movements, e.g. doorbell reactions. Some occur on getting out of bed. 13% under states of high negative emotions. Amer Stroke Assoc meeting. San Antonio AP 2/9/02. Short men in lowest quartile 54% more strokes than tallest quartile in Tel Aviv study with average height 5’6. Lowest education 50% more stroke than highest. Fewer families and financial stresses also associate with fewer strokes.

Shaving Less, More Strokes, More Deaths: 20-year study of over 2,000 men ages 45-59 in Caerphilly, south Wales. The 500 infrequent shavers had 70% more stroke and 31% increased likelihood of dying with 45% death rate vs 31%. Am J Epid & Reuters 2/5/03. U Bristol. Theory that may have less testosterone in body. Also infrequent shavers more likely to be smokers and manual workers, to be shorter, unmarried, and to have fewer orgasms. Shah Ebrahim. Ed: Shaving less, means your beard is growing less rapidly, which is a sign of aging.  Thus, not surprisingly, those who were aging faster were more likely to die.

Teeth: Fewer = More Strokes: The Health Professionals Study of 41,380 male dentists, osteopaths, etc. ages 40-75, follow-up found 57% more strokes if fewer than 25 teeth at start. 16 or fewer, 70% more ischemic stroke. Not related to diet or smoking. Best study to date. Harvard. Stroke:JAHA 12/13/02

Thrombolytic Therapy for Strokes Might Kill More People than It Saves: Thrombolytic therapy after a stroke has shown substantial benefits in neural outcomes. However, in a meta-analysis of DB PC study of acute ischemic stroke patients, eleven studies involving 3709 patients found thrombolytic therapy was associated with an insignificant 7% increase in mortality (OR 1.07; P = .3) or an increased risk of mortality of 11 per 1000 persons (P = .3) or one in 84 patients. Is thrombolytic therapy associated with increased mortality?: meta-analysis of randomized controlled trials. Ergin A, Ergin N. Tulane University. Arch Neurol. 2005 Mar;62(3):362-6. Ed: I'm not a neurologist, but thrombolytic therapy doesn't sound that good.  I thought it was supposed to be a miracle from heaven.

Whole Grains Big Help: compared with women in the lowest quintile of whole grain intake, women in the highest quintile of whole grain intake (2.7 servings per day) had a 43% lower risk of ischemic stroke. Nurses’ Study of over 75,000 for 14 yr. JAMA 9/2000

Vitamin D Lower in Stroke Victims; Iron Lower in Heart Attacks and Strokes: In a population-based health survey of 755 adults ages 65-99 with 10 years follow-up, 130 had heart attacks and 70 had strokes. Low intake of vitamin D (p=0.011) and low serum levels of 1,25-dihydroxy-vitamin D (p=0.0053) were predictive of stroke when adjusted for age, gender, smoking and functional capacity. High dietary intakes of two flavonoids, luteolin (p=0.0096) and kaempferol (p=0.002) were associated with lowered risk of heart attack. Low serum levels of iron predicted both heart attack (p=0.013) and stroke (p=0.019). Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Marniemi J, et al. National Public Health Institute, Turku, Finland. Nutr Metab Cardiovasc Dis. 2005 Jun;15(3):188-97

HBP, Smoking, High Uric Acid, High Serum Potassium Risk Factors: 3282 subjects 65+ years in the CASTEL, a population-based study in Northeast Italy. Historical and clinical data, blood tests and 14-year fatal events were recorded. Continuous items were divided into quintiles and, for each quintile, adjusted relative risk (RR). Age, historical stroke (RR: 5.2) and coronary artery disease (RR: 1.38), atrial fibrillation (RR: 2.40), arterial hypertension (RR: 1.33), systolic blood pressure > or = 163 mmHg (RR: 1.84), pulse pressure > or = 74 mmHg (RR: 1.50), cigarette smoking (RR: 1.60), electrocardiographic left ventricular hypertrophy (RR: 1.72), impaired glucose tolerance (IGT, RR: 1.83), uric acid (UA) > 0.38 mmol/l (RR: 1.61), serum potassium > or = 5 mEq/l (RR: 1.70) and serum sodium < or = 139 mEql/l (RR: 1.34) increased the risk of stroke. In the CASTEL, stroke was the first cardiovascular cause of death. U Padova. Predictors of stroke mortality in elderly people from the general population. The CArdiovascular STudy in the ELderly. Mazza A, Pessina AC, Pavei A, Scarpa R, Tikhonoff V, Casiglia E. Eur J Epidemiol. 2001;17(12):1097-104