STROKES
PASSIVE SMOKING, NOT JUST ACTIVE SMOKING, INCREASES RISK
OF ACUTE STROKE
Recent research from New Zealand has shown that exposure
to environmental tobacco smoke (passive smoking) significantly
increases the risk of acute stroke among non-smokers or
long-term ex-smokers. The study consisted of 521 patients
with a first ever stroke and 1,851 controls. After adjustment
for potential confounders, exposure to environmental tobacco
smoke among non-smokers and people who had not smoked for
more than 10 years was associated with a significantly increased
risk of stroke (odds ratio 1.82). The study also confirmed
the increased risk of stroke among active smokers compared
with non-smokers and ex-smokers (OR 4.14).
Bradbury, J.
LANCET 1999, 354 (9179) 653
LIGHT-TO-MODERATE ALCOHOL CONSUMPTION AND THE RISK OF
STROKE AMONG U.S. MALE PHYSICIANS
Stroke is a leading cause of morbidity and mortality in
many countries. Studies in North America and Europe have
found a U- or J-shaped association, suggesting that moderate
consumption of alcohol provides protection against ischemic
stroke. However, the definition of moderate consumption
has differed substantially among studies. Therefore, researchers
evaluated the effect of light-to-moderate alcohol intake
on the risk of stroke in a cohort study of 22,071 male physicians
aged 40 to 84 years. At base line, participants had no history
of stroke, transient ischemic attack, or myocardial infarction
and were free of cancer. Alcohol intake ranged from none
or almost none to two or more drinks per day. During an
average of 12.2 years of follow-up, 679 strokes were reported.
It was found that compared with participants who had less
than one drink per week, those who drank more had a reduced
overall risk of stroke (relative risk, 0.79) and a reduced
risk of ischemic stroke (relative risk, 0.77). The overall
relative risks of stroke for the men who had one drink per
week, two to four drinks per week, five or six drinks per
week, or one or more drinks per day were 0.78, 0.75, 0.83,
and 0.80 respectively. There was no statistically significant
association between alcohol consumption and haemorrhagic
stroke.
Thus, light to moderate alcohol consumption reduces the
overall risk of stroke and the risk of ischemic stroke in
men. Greater consumption, up to one drink per day, does
not increase the observed benefit.
Berger, K. et al
N. ENGL. J. MED. 1999, 341 (21) 1557-64
EFFECTS OF PHYSICAL ACTIVITY AND VENTILATORY FUNCTION
ON RISK FOR STROKE IN MEN
Stroke is a major cause of illness, death, and health expenditures.
Physical activity has been found to confer favourable changes
on many cardiovascular risk factors and to reduce the risk
for cardiovascular disease and cancer. Therefore, a study
was carried out to examine the association of leisure-time
physical activity and pulmonary function with risk for stroke.
Participants in the study were 4,484 men aged 45 to 80
years who were followed for a mean of 10.6 ?3.6 years. It
was found that new stroke developed in 249 men (5.6%). Of
these 44 (18%) were haemorrhagic and 205 (82%) ischemic.
After controlling for known risk factors for cerebrovascular
disease, leisure-time physical activity maintained after
40 years of age was associated with a reduced risk for stroke:
relative risk, 0.69 for total stroke and 0.62 for ischemic
stroke. Also, risk for stroke increased with diminishing
ventilatory function: relative risk, 1.9 for the lowest
compared with the highest quintile.
Thus, middle-aged men who participate in leisure-time physical
activity and have good pulmonary function seem to have a
lower risk for stroke than men who are not active or have
diminished pulmonary function.
Agnarsson, U. et al,
ANN. INT. MED. 1999, 130 (12) 987-90
FRUIT AND VEGETABLE CONSUMPTION IN LATER LIFE
Fruit and vegetable consumption may reduce the risk of
several chronic diseases, including cancers, cardiovascular
disease, coronary heart disease, hypertension and stroke.
The World Health Organisation therefore recommends the consumption
of at least 400g, or 5 portions of fruit and vegetables
a day. Most adults’ consumption falls short of this
recommendation, so a study was carried out to assess the
levels of fruit and vegetable consumption in elderly people,
and to examine the socio-economic, physical and psychological
factors which influence this consumption. The subject group
was 445 elderly people (aged 65+) living in the East Midlands.
The recommended target of 5 portions of fruit and vegetables
a day was achieved by less than half the respondents: 37%
of those living in the urban area and 51% of those living
in the rural area. Low fruit and vegetable consumption was
particularly associated with being male, smoking and having
low levels of social engagement. Health programmes promoting
fruit and vegetable consumption may not be successfully
reaching elderly people and need to target those particularly
at risk of low consumption.
Johnson, A.E. et al
AGE & AGEING 1998, 27 (6) 723-8
FREQUENCY OF MAJOR COMPLICATIONS OF ASPIRIN, WARFARIN,
AND INTRAVENOUS HEPARIN FOR SECONDARY STROKE PREVENTION
Ischaemic stroke affects approximately 450,000 persons
in the United States each year, and recurrent stroke is
a major cause of stroke-associated morbidity and death.
Therefore, a population-based historical cohort study was
undertaken to determine complication rates for aspirin,
warfarin, and intravenous heparin administered for secondary
stroke prevention after first episodes of ischaemic stroke,
transient ischaemic attack, or amaurosis fugax in a community.
It was found that 20 aspirin-associated complications (1
fatal) occurred during an average 0.7 years of treatment,
and 3 heparin-associated complications (1 fatal) occurred
during an average 5.1 days of treatment. Complication rates
were 3.5 per 100 person-years for aspirin, 7.9 per 100 person-years
for warfarin, and 0.30 per 100 person-days for heparin.
Thus, after adjustment for duration of therapy, complication
rates for heparin were higher than those for aspirin or
warfarin.
Petty, G.W. et al
ANN .INTER. MED. 1999, 130 (1) 14-22
EXERCISE PREVENTS STROKE AND IMPROVES RECOVERY FROM STROKE
A 13-year study of more than 11,000 men showed that those
who took moderate exercise (equivalent to a hour’s
brisk walk 5 days a week) had a 46% lower stroke risk than
those who did little or no exercise. The biggest reduction
in stroke risk was associated with an energy expenditure
of 2000-2999 kcal/week. The US study showed that walking,
stair climbing, dancing, cycling and gardening reduced the
risk of stroke and that the lowest risk was associated with
walking 20 km or more each week. Patients who had had a
mild or moderate stroke were given three 1.5-hour intensive
sessions every week for 8 weeks. These patients had greater
improvement in lower extremity motor function and gait speed
than control patients who received usual physician care
only.
Bonn, D.
LANCET 1998, 352 (9135) 1201
GINSENG AND WARFARIN
A possible interaction between warfarin and Ginseng (Panax
ginseng) has been reported. A 47-year-old man had been taking
warfarin for 5 years following the insertion of a mechanical
heart valve. His International Normalized Ratio (INR) had
ranged from 3.0 to 4.0 for 9 months. In February 1995 the
patient started taking Ginseng capsules (Ginsana) 3 times
daily. Two weeks later his INR dropped to 1.5. After the
Ginseng was discontinued it returned to 3.3 in 2 weeks,
i.e. the Ginseng appeared to reduce the effectiveness of
the warfarin.
AMERICAN J. HEALTH-SYSTEM PHARMACY 1997, 54, 692-3
Courtesy Kerry Bone, MODERN PHYTOTHERAPIST 1998, Vol. 4,
No. 1, 35
