中风高危人群补充维生素E和β-胡萝卜素：α-生育酚、β-胡萝卜素预防癌症研究的亚组分析

Vitamin E and beta carotene supplementation in high risk for stroke: a subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.

作者信息

Leppälä J M, Virtamo J, Fogelholm R, Albanes D, Taylor P R, Heinonen O P

机构信息

Department of Public Health, University of Helsinki, PO Box 41, 00014 Helsinki, Finland.

出版信息

Arch Neurol. 2000 Oct;57(10):1503-9. doi: 10.1001/archneur.57.10.1503.

DOI:10.1001/archneur.57.10.1503

PMID:11030804

Abstract

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. Arch Neurol. 2000;57:1503-1509

摘要

背景

血清或饮食中维生素E和β-胡萝卜素水平较高似乎与中风风险较低相关，但关于补充这些物质的研究并不支持其用于预防中风。

目的

确定维生素E（dl-α生育酚）和β-胡萝卜素补充剂是否可用于预防有出血性或缺血性事件高风险的男性中风。

设计

基于人群的随机、双盲、安慰剂对照的2×2析因设计试验（α-生育酚、β-胡萝卜素癌症预防研究），于1985年4月至1993年4月30日进行，中位随访6年。

干预措施

α-生育酚50毫克；β-胡萝卜素20毫克；两者都用；或安慰剂。

参与者

从芬兰西南部年龄在50至69岁的男性总人口（n = 290,406）中，29,133名男性吸烟者被随机分配到4种治疗方案中的一种。由于基线时有中风史，我们排除了614名男性，剩余28,519名。

主要观察指标

新发和致命性蛛网膜下腔出血、脑出血、脑梗死及未明确类型的中风。

结果

共有1057名男性发生中风：85例为蛛网膜下腔出血，112例为脑出血，807例为脑梗死，5,3例为未明确类型的中风。发病后90天内，160名男性死于中风。补充维生素E增加了高血压男性蛛网膜下腔出血的风险（相对风险[RR]，2.45；95%置信区间[CI]，1.08 - 5.55），降低了脑梗死的风险（RR，0.70；95% CI，0.55 - 0.89），但在血压正常的男性中无此作用。此外，在同时患有糖尿病的高血压男性中，它降低了脑梗死的风险，且未增加蛛网膜下腔出血的风险（RR，0.33；95% CI，0.14 - 0.78）。补充β-胡萝卜素似乎增加了饮酒量较大男性脑出血的风险，并适度降低了脑梗死的风险。