Life Extension Magazine April 2005
A New Paradigm for Stroke Prevention
Reducing stroke risk by reversing carotid and aortic plaque is becoming an everyday reality, as more and better tools become available to us. To determine your own stroke risk, the best and most widely available imaging tool is carotid ultrasound, which aims to identify carotid plaque or intima-media thickness of more than 1.0 mm. Any degree of calcification of the aorta, such as that indicated by a CT heart scan, is another useful measure of risk. A prior transient ischemic attack, or “mini-stroke,” also puts you at heightened risk for future stroke.
Treatment to reduce risk is multifaceted and should examine all sources of risk, such as metabolic syndrome and levels of small LDL, lipoprotein(a), and C-reactive protein. Fish oil is the one crucial ingredient in any stroke-prevention program. Other supplements can be used in a targeted fashion, depending on the sources of carotid or aortic plaque. Ideally, repeat scanning of the carotids should be performed some years after beginning your treatment program to assess whether you have successfully reversed plaque growth.
1. Clark TG, Murphy MF, Rothwell PM. Long term risks of stroke, myocardial infarction, and vascular death in “low risk” patients with a non-recent transient ischaemic attack. J Neurol Neurosurg Psychiatry. 2003 May;74(5):577-80.
2. Amarenco P, Cohen A, Tzourio C, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994 Dec 1;331(22):1474-9.
3. Ebrahim S, Papacosta O, Whincup P, et al. Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study. Stroke. 1999 Apr;30(4):841-50.
4. Hollander M, Hak AE, Koudstaal PJ, et al. Comparison between measures of atherosclerosis and risk of stroke: the Rotterdam Study. Stroke. 2003 Oct;34(10):2367-72.
5. Hollander M, Bots ML, Del Sol AI, et al. Carotid plaques increase the risk of stroke and subtypes of cerebral infarctions in the asymptomatic elderly: the Rotterdam study. Circulation. 2002 Jun 18;105(24):2872-7.
6. MacMahon S, Rodgers A, Neal B, Chalmers J. Blood pressure lowering for the secondary prevention of myocardial infarction and stroke. Hypertension. 1997 Feb;29(2):537-8.
7. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560-72.
8. Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004 Nov 10;292(18):2217-25.
9. Jood K, Jern C, Wilhelmsen L, Rosengren A. Body mass index in mid-life is associated with a first stroke in men: a prospective population study over 28 years. Stroke. 2004 Dec;35(12):2764-9.
10. Kernan WN, Inzucchi SE. Type 2 Diabetes Mellitus and Insulin Resistance: Stroke Prevention and Management. Curr Treat Options Neurol. 2004 Nov;6(6):443-50.
11. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356-9.
12. Watarai T, Yamasaki Y, Ikeda M, et al. Insulin resistance contributes to carotid arterial wall thickness in patients with non-insulin-dependent-diabetes mellitus. Endocr J. 1999 Oct;46(5):629-38.
13. Bonora E, Kiechl S, Willeit J, et al. Carotid atherosclerosis and coronary heart disease in the metabolic syndrome: prospective data from the Bruneck study. Diabetes Care. 2003 Apr;26(4):1251-7.
14. Landray MJ, Sagar G, Muskin J, et al. Association of atherogenic low-density lipoprotein subfractions with carotid atherosclerosis. QJM. 1998 May;91(5):345-51.
15. Hodis HN, Mack WJ, Dunn M, et al. Intermediate-density lipoproteins and progression of carotid arterial wall intima-media thickness. Circulation. 1997 Apr 15;95(8):2022-6.
16. Gronholdt ML, Nordestgaard BG, Wiebe BM, Wilhjelm JE, Sillesen H. Echo-lucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content. Circulation. 1998 Jan 6;97(1):34-40.
17. Hodis HN, Mack WJ, LaBree L, et al. Reduction in carotid arterial wall thickness using lovastatin and dietary therapy: a randomized controlled clinical trial. Ann Intern Med. 1996 Mar 15;124(6):548-56.
18. Wallenfeldt K, Bokemark L, Wikstrand J, Hulthe J, Fagerberg B. Apolipoprotein B/apolipoprotein A-I in relation to the metabolic syndrome and change in carotid artery intima-media thickness during 3 years in middle-aged men. Stroke. 2004 Oct;35(10):2248-52.
19. Peltier M, Iannetta Peltier MC, Sarano ME, et al. Elevated serum lipoprotein(a) level is an independent marker of severity of thoracic aortic atherosclerosis. Chest. 2002 May;121(5):1589-94.
20. Zenker G, Koltringer P, Bone G, et al. Lipoprotein(a) as a strong indicator for cerebrovascular disease. Stroke. 1986 Sep;17(5):942-5.
21. Rothwell PM, Howard SC, Power DA, et al. Fibrinogen concentration and risk of ischemic stroke and acute coronary events in 5113 patients with transient ischemic attack and minor ischemic stroke. Stroke . 2004 Oct;35(10):2300-5.
22. Mauriello A, Sangiorgi G, Palmieri G, et al. Hyperfibrinogenemia is associated with specific histocytological composition and complications of atherosclerotic carotid plaques in patients affected by transient ischemic attacks. Circulation. 2000 Feb 22;101(7):744-50.
23. Ridker PM, Cook N. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham Risk Scores. Circulation. 2004 Apr 27;109(16):1955-9.
24. Hashimoto H, Kitagawa K, Hougaku H, et al. C-reactive protein is an independent predictor of the rate of increase in early carotid atherosclerosis. Circulation. 2001 Jul 3;104(1):63-7.
25. Tribouilloy CM, Peltier M, Iannetta Peltier MC, et al. Plasma homocysteine and severity of thoracic aortic atherosclerosis. Chest. 2000 Dec;118(6):1685-9.
26. Lentz SR, Rodionov RN, Dayal S. Hyperhomocysteinemia, endothelial dysfunction, and cardiovascular risk: the potential role of ADMA. Atheroscler Suppl. 2003 Dec;4(4):61-5.
27. Graham IM, Daly LE, Refsum HM, et al. Plasma homocysteine as a risk factor for vascular disease. The European Concerted Action Project. JAMA. 1997 Jun 11;277(22):1775-81.
28. Nygard O, Nordrehaug JE, Refsum H, et al. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997 Jul 24;337(4):230-6.
29. Amarenco P, Labreuche J, Lavallee P, Touboul PJ. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke. 2004 Dec;35(12):2902-9.
30. Corti R, Fuster V, Fayad ZA, et al. Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years’ follow-up by high-resolution noninvasive magnetic resonance imaging. Circulation. 2002 Dec 3;106(23):2884-7.
31. Kent SM, Coyle LC, Flaherty PJ, Markwood TT, Taylor AJ. Marked low-density lipoprotein cholesterol reduction below current national cholesterol education program targets provides the greatest reduction in carotid atherosclerosis. Clin Cardiol. 2004 Jan;27(1):17-21.
32. He K, Rimm EB, Merchant A, et al. Fish consumption and risk of stroke in men. JAMA. 2002 Dec 25;288(24):3130-6.
33. Hino A, Adachi H, Toyomasu K, et al. Very long chain N-3 fatty acids intake and carotid atherosclerosis: an epidemiological study evaluated by ultrasonography. Atherosclerosis. 2004 Sep;176(1):145-9.
34. Thies F, Garry JM, Yaqoob P, et al. Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomised controlled trial. Lancet. 2003 Feb 8;361(9356):477-85.
35. Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Arterioscler Thromb Vasc Biol. 2003 Feb 1;23(2):e20-30.
36. Rosenfeldt F, Hilton D, Pepe S, Krum H. Systematic review of effect of coenzyme Q10 in physical exercise, hypertension and heart failure. Biofactors. 2003;18(1-4):91-100.
37. Langsjoen PH, Langsjoen PH, Folkers K. Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. Clin Investig. 1993;71(8Suppl):S140-4.
38. Langsjoen P, Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med. 1994;15 SupplS265-72.
39. Stewart KJ, Bacher AC, Turner K, et al. Exercise and risk factors associated with metabolic syndrome in older adults. Am J Prev Med. 2005 Jan;28(1):9-18.
40. Seshadri P, Iqbal N, Stern L, et al. A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. Am J Med. 2004 Sep 15;117(6):398-405.
41. Lara-Castro C, Garvey WT. Diet, insulin resistance, and obesity: zoning in on data for Atkins dieters living in South Beach. J Clin Endocrinol Metab. 2004 Sep;89(9):4197-205.
42. Udani J, Hardy M, Madsen DC. Blocking carbohydrate absorption and weight loss: a clinical trail using Phase 2 brand proprietary fractionated white bean extract. Altern Med Rev. 2004 Mar;9(1):63-9.
43. Walsh DE, Yaghoubian V, Behforooz A. Effect of glucomannan on obese patients: a clinical study. Int J Obes. 1984;8(4):289-93.
44. Heilbronn LK, Noakes M, Clifton PM. The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control. J Am Coll Nutr. 2002 Apr;21(2):120-7.
45. Arlt W. Dehydroepiandrosterone replacement therapy. Semin Reprod Med. 2004 Nov;22(4):379-88.
46. Villareal DT, Holloszy JO. Effect of DHEA on abdominal fat and insulin action in elderly women and men: a randomized controlled trial. JAMA. 2004 Nov 10;292(18):2243-8.
47. Wu H, Dwyer KM, Fan Z, et al. Dietary fiber and progression of atherosclerosis: the Los Angeles Atherosclerosis Study. Am J Clin Nutr. 2003 Dec;78(6):1085-91.
48. Hackam DG, Peterson JC, Spence JD. What level of plasma homocyst(e)ine should be treated? Effects of vitamin therapy on progression of carotid atherosclerosis in patients with homocyst(e)ine levels above and below 14 micromol/L. Am J Hypertens. 2000 Jan;13(1 Pt 1):105-10.
49. Toole JF, Malinow MR, Chambless LE, et al. 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. JAMA. 2004 Feb 4;291(5):565-75.