Decreased levels of the omega 3 fatty acid EPA associated risk intracerebral hemorrhage

Decreased levels of the omega-3 fatty acid EPA associated with greater risk of intracerebral hemorrhage

Life Extension Update

Tuesday, March 17, 2015. The March 2015 issue of the journal Nutrition Research published the discovery of scientists at Japan's Tokai University School of Medicine of a protective effect for the omega-3 fatty acid eicosapentaenoic acid (EPA) against the risk of intracerebral hemorrhage, which is characterized by bleeding in the brain.

"Omega-3 fatty acids, including eicosapentaenoic acid, prevent ischemic stroke," write Yoshimori Ikeya and colleagues. "The preventive effect has been attributed to an antithrombic effect induced by elevated EPA and reduced arachidonic acid (AA) levels. However, the relationship between intracranial hemorrhage and omega-3 fatty acids has not yet been elucidated."

The study included 70 men and women whose first intracerebral hemorrhage had occurred within 30-60 days, matched with 66 control subjects with no stroke history. Fasting blood samples were analyzed for plasma EPA, docosahexaenoic acid (DHA), arachidonic acid and other factors. Dietary questionnaire responses provided information concerning the participants' intake of fish (the most common source of omega-3 fatty acids) as well as other information.

Subjects who had been diagnosed with intracerebral hemorrhage had significantly higher diastolic blood pressure and other factors, lower EPA levels, and a lower average ratio of EPA to AA. Further analysis of the data revealed that low EPA was a risk factor for those aged 65 years and older.

While omega-3 fatty acids have been linked with protection against ischemic stroke, their ability to help reduce blood clotting has led to speculation that the fatty acids could increase the risk of hemorrhagic stroke, which the current finding contradicts. Dr Ikeya and colleagues note that intracerebral hemorrhages are believed to be caused by the rupture of small penetrating arteries and that changes induced by chronic hypertension can reduce these arteries' compliance (ability to distend with pressure). In addition to the antihypertensive effect of EPA, atherosclerotic plaques readily incorporate the fatty acid, resulting in plaque that has less inflammation and greater stability. "We suspect that atherosclerosis, lower compliance, and the instability of the walls of the small penetrating arteries in the brain that are produced by lower EPA concentrations eventually induce intracerebral hemorrhages," the authors write.

"Lower EPA concentrations and EPA/AA ratios were found to be risk factors for intracerebral hemorrhage in addition to previously known risk factors such as blood pressure, alcohol consumption, and lifestyle," they conclude.


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Higher vitamin C levels linked to lower risk of hemorrhagic stroke
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A presentation at the American Academy of Neurology's 66th Annual Meeting, held in Philadelphia from April 26 to May 3, 2014, revealed a protective effect for high plasma levels of vitamin C against the risk of hemorrhagic stroke. Hemorrhagic stroke is characterized by bleeding in the brain and, although less common than ischemic stroke, is associated with a greater risk of mortality.

"Scurvy is caused by vitamin C deficiency, specifically a plasma vitamin C concentration of less than 11 micromoles per liter, and may have hemorrhagic manifestations," write authors Stèphane Vannier, MD, of Pontchaillou University Hospital in Rennes, France and colleagues. "Vitamin C depletion (less than 38 micromoles per liter) is associated with cardiovascular diseases and could increase intracerebral hemorrhage risk."

The researchers compared plasma ascorbate levels of 65 acute intracerebral hemorrhage patients with an equal number of control subjects. Subjects with stroke had depleted vitamin C levels averaging 35.3 micromoles per liter, in comparison with the control group, whose levels were normal at an average of 56.2 micromoles per liter. Depleted levels of vitamin C were also associated with longer hospitalization.

"Our results show that vitamin C deficiency should be considered a risk factor for this severe type of stroke, as were high blood pressure, drinking alcohol and being overweight in our study," Dr Vannier stated. "More research is needed to explore specifically how vitamin C may help to reduce stroke risk. For example, the vitamin may regulate blood pressure."

"There are multiple physiopathological mechanisms given the involvement of vitamin C in blood pressure regulation and collagen synthesis," the authors note. "Additional work is required to confirm our findings."


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Health Concern


There are two main kinds of stroke, ischemic stroke, which makes up about 87% of all strokes, and hemorrhagic stroke (Roger 2012). Transient ischemic attacks (TIAs) and silent strokes are less severe types of stroke, but both can have long-term consequences such as memory impairment (Blum 2012; Wang 2013; NICE 2008; NSA 2009; Das 2008).

Strokes caused by blood vessel(s) breaking and leaking blood into the brain are called hemorrhagic strokes. Hemorrhagic strokes account for about 13% of all strokes, but are responsible for more than 30% of all stroke deaths. There are 2 types of hemorrhagic stroke: subarachnoid and intracerebral (NSA 2012b, Roger 2012).

  • Intracerebral hemorrhage. Intracerebral hemorrhage is the most common form of hemorrhagic stroke. It occurs when a blood vessel within the brain ruptures and leaks blood into the surrounding tissue. High blood pressure is the primary cause of this type of hemorrhage. Most intracerebral hemorrhages are accompanied by a sudden onset of symptoms, such as loss of consciousness, nausea or vomiting, numbness of the face, or severe headache with no known cause (NSA 2009a).

  • Subarachnoid hemorrhage. Subarachnoid hemorrhage is usually caused by an aneurysm, a bulge in a blood vessel wall, bursting in a large artery on or near the delicate membrane surrounding the brain. Blood spills into the area around the brain, which is filled with protective cerebrospinal fluid (CSF). This causes the brain to be surrounded by blood-contaminated CSF. While there are no warning signs for a subarachnoid hemorrhage, symptoms could include a sudden severe headache often described by patients as the "worst headache of my life." At least 30% of subarachnoid hemorrhages lead to a condition called vasospasm, which occurs when blood vessels irritated by excess blood begin to spasm and narrow in size. This makes it difficult to supply the brain with enough blood to survive.
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