I have a family history of hemorrhagic stroke. No history of ischemic stroke, and very few heart attacks. Additionally, I think I personally have a very low risk of heart attack from my lifestyle. That leaves a high risk of hemorrhagic stroke.
I have been looking at ways to lower my risk. Amazingly, the risk factors for hemorrhagic stroke (aka: intracerebral hemorrhage) are often the exact opposite compared to ischemic stroke or heart attack.
Risks for hemorrhagic stroke:
- LOW Total Cholesterol
- LOW LDL
- HIGH HDL
- LOW Triglycerides
- LOW Protein diet
- LOW Saturated fat
Associated with lower risk of hemorrhagic stroke:
- Egg consumption
- Animal protein
Should I start eating lots of eggs and animal protein?
If not, how do you explain these associations?
Or, what's really going on here?
References: (You can find conflicting studies.)
Stroke. 2013 Jul;44(7):1833-9.
Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis.
Wang X1, Dong Y, Qi X, Huang C, Hou L.
"Total cholesterol level is inversely associated with risk of hemorrhagic stroke. Higher level of low-density lipoprotein cholesterol seems to be associated with lower risk of hemorrhagic stroke. High-density lipoprotein cholesterol level seems to be positively associated with risk of intracerebral hemorrhage."
PMID: 23704101
Stroke. 2013 May;44(5):1354-9.
Lipid profile, lipid-lowering medications, and intracerebral hemorrhage after tPA in get with the guidelines-stroke.
Messé SR1, Pervez MA, Smith EE, Siddique KA, Hellkamp AS, Saver JL, Bhatt DL, Fonarow GC, Peterson ED, Schwamm LH.
"...higher high density lipoprotein and lower triglyceride levels were modest risk factors."
PMID: 23493734
BMJ. 2013 Jan 7;346:e8539.
Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies.
Rong Y1, Chen L, Zhu T, Song Y, Yu M, Shan Z, Sands A, Hu FB, Liu L.
"...reduced risk of hemorrhagic stroke associated with higher egg consumption in subgroup analyses warrant further studies."
PMID: 23295181
Ann Indian Acad Neurol. 2012 Jan;15(1):19-22.
Low cholesterol as a risk factor for primary intracerebral hemorrhage: A case-control study.
Valappil AV1, Chaudhary NV, Praveenkumar R, Gopalakrishnan B, Girija AS.
"This study confirms an increased risk of primary ICH associated with low cholesterol both in men and women, especially in older individuals."
PMID: 22412267
Arterioscler Thromb Vasc Biol. 2011 Dec;31(12):2982-9.
Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study.
Wieberdink RG1, Poels MM, Vernooij MW, Koudstaal PJ, Hofman A, van der Lugt A, Breteler MM, Ikram MA.
"Low serum triglyceride levels were associated with an increased risk of intracerebral hemorrhage and with the presence of deep or infratentorial cerebral microbleeds."
PMID: 21921260
Stroke. 2011 Sep;42(9):2447-52.
Serum low-density lipoprotein cholesterol level predicts hematoma growth and clinical outcome after acute intracerebral hemorrhage.
Rodriguez-Luna D1, Rubiera M, Ribo M, Coscojuela P, Pagola J, Piñeiro S, Ibarra B, Meler P, Maisterra O, Romero F, Alvarez-Sabin J, Molina CA.
"Lower serum LDL-C level independently predicts [hematoma growth], early neurological deterioration, and 3-month mortality after acute [intracerebral hemorrhage]."
PMID: 21799167
J Lipid Res. 2011 Sep;52(9):1747-54.
Inverse association of plasma level of high-density lipoprotein cholesterol with intracerebral hemorrhage.
Wang X1, Li S, Bai Y, Fan X, Sun K, Wang J, Hui R.
"...low plasma HDL-C (<1.38 mmol/l) may be associated with risk of ICH."
PMID: 21680619
EPMA J. 2011 Mar;2(1):75-81.
Associations of impaired glucose metabolism and dyslipidemia with cardiovascular diseases: what have we learned from Japanese cohort studies for individualized prevention and treatment?
Kokubo Y1.
"...lower LDL-C levels may pose an increased risk of intracerebral hemorrhage in Japan."
PMID: 231991
Cerebrovasc Dis. 2011;31(1):100-6.
Blood pressure and total cholesterol level are critical risks especially for hemorrhagic stroke in Akita, Japan.
Suzuki K1, Izumi M, Sakamoto T, Hayashi M.
"High BP and low [total cholesterol] (<160 mg/dl) were critical risks of hemorrhagic stroke."
PMID: 21079399
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Mar;38(3):268-71.
[Prospective study on associations between levels of total cholesterol, triglyceride and risk of ischemic and hemorrhagic strokes].
Jiang B1, Fang XH, Liu YH, Dai XY, Lin ZG, Su FZ, Yang QD, Wang WZ, Wu SP, Li SC.
"low TC was related with increased risk of hemorrhagic stroke."
PMID: 20450572
Atherosclerosis. 2010 May;210(1):243-8.
Triglycerides and risk of hemorrhagic stroke vs. ischemic vascular events: The Three-City Study.
Bonaventure A1, Kurth T, Pico F, Barberger-Gateau P, Ritchie K, Stapf C, Tzourio C.
"...low triglycerides levels were associated with an increased risk of hemorrhagic stroke..."
PMID: 19963214
Acta Neurol Scand. 2009 Mar;119(3):151-4.
Association of low cholesterol with primary intracerebral haemorrhage: a case control study.
Orken DN1, Kenangil G, Celik M, Mail Z, Kayaalp H, Erginoz E, Forta H.
"Individuals with lower cholesterol levels have an increased risk of ICH. Therefore, before treatment with statins, clinicians must be aware of the possible ICH risk."
PMID: 18684213
MEDICC Rev. 2008 Apr;10(2):27-32.
Association between Blood Lipids and Types of Stroke.
González S1, Fernández O, Fernández R, Menéndez C, Maza J, González-Quevedo A, Buergo MA.
"...low total cholesterol levels and high triglycerides levels are associated with the [cerebral hemorrhage] occurrence."
PMID: 21483365
Am J Epidemiol. 2003 Jan 1;157(1):32-9.
Fat and protein intakes and risk of intraparenchymal hemorrhage among middle-aged Japanese.
Iso H1, Sato S, Kitamura A, Naito Y, Shimamoto T, Komachi Y.
"Intake of animal protein tended to correlate inversely with risk; the relative risk with a one standard deviation increase in animal protein intake (17.6 g/day) was 0.79 (95% CI: 0.61, 1.02); p = 0.07. Results are similar to those recently reported for US women and together help to explain the high rate of this stroke subtype in Asian countries, where intakes of these nutrients are low."
PMID: 12505888
Circulation. 2001 Feb 13;103(6):856-63.
Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women.
Iso H1, Stampfer MJ, Manson JE, Rexrode K, Hu F, Hennekens CH, Colditz GA, Speizer FE, Willett WC.
"Low intake of saturated fat and animal protein was associated with an increased risk of intraparenchymal hemorrhage, which may help to explain the high rate of this stroke subtype in Asian countries. The increased risk with low intake of saturated fat and trans unsaturated fat is compatible with the reported association between low serum total cholesterol and risk."
PMID: 11171795
