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Nutritional and metabolic aspects of stroke prevention.

Epidemiologic evidence, animal studies, angiographic and ultrasound studies in humans, and a limited number of clinical trials suggest that vitamins C and E may be protective and that folate, B6, and B12, by lowering homocysteine levels, may reduce stroke. However, these hypotheses require testing before widespread use of supplementary vitamins can be generally recommended (62). Clinical trials under way will test those hypotheses. In the meantime, it should be understood that the role of diet is much more important than is widely recognized. A diet low in saturated fat and cholesterol, low in sodium, high in potassium and calcium, and containing a lot of fruits and vegetables reduces blood pressure as much as an antihypertensive drug and in coronary patients is twice as effective as statin drugs in reducing death and myocardial infarction. Such a diet can therefore be confidently recommended as a source not only of natural proportions of vitamins and antioxidants but also for benefits that we are only beginning to define.