The New York Times is a well-respected publication, and its readers expect accurate information from both the publication and its associated web content. So I was stunned to read not only incorrect but potentially dangerous information in the New York Times Hemorrhagic Stroke In-depth Prevention Report, part of the Times Health Guide. A large section of the report was devoted to anti-platelet and anti-coagulant medications, when these drugs do not prevent hemorrhagic strokes – in fact, they have the opposite effect; they increase the risk of death from hemorrhagic stroke. The information on anti-coagulants in the NYT report refer only to ischemic stroke, not hemorrhagic stroke. Anticoagulants should not have been mentioned here, unless as something to avoid. In fact, prior aspirin use has furthermore been cited as a predictor of death from hemorrhagic stroke. Also, any anti-platelet or anti-coagulant medication (not only aspirin) will carry a risk of bleeding, and therefore is not an appropriate preventive measure for hemorrhagic stroke.
The report also failed to communicate the fact that ischemic and hemorrhagic stroke do not share the same risk factors. Although high blood pressure is the foremost risk factor for both ischemic and hemorrhagic strokes, other common risk factors for ischemic stroke are not risk factors for hemorrhagic stroke – especially high LDL cholesterol. In fact, studies have found that low saturated fat and animal protein intake and low serum cholesterol, which would reduce risk of heart attacks and ischemic stroke, are associated with increased risk for hemorrhagic stroke. Although the report mentioned that statin use may increase the risk of hemorrhagic stroke, it failed to explain that low cholesterol does not protect against hemorrhagic stroke, and may increase one’s risk of hemmorhagic stroke, especially in the presence of high blood pressure.
For prevention of hemorrhagic stroke, keeping blood pressure in a safe range is of paramount importance. This is especially important for those who already are eating athero-protective diets, rich in whole plant foods and minimizing animal products and processed foods to reduce risk of heart disease, ischemic stroke and cancer. A health-promoting diet, salt restriction, and exercise – not anti-coagulant medications – should be emphasized, as lifestyle strategies to maintain favorable blood pressure reduce the risk of hemorrhagic stroke.
I hope that my comments will prompt The New York Times to revise and correct its report on hemorrhagic stroke prevention.
More information on hemorrhagic stroke.
1. Saloheimo P, Ahonen M, Juvela S, et al. Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke. 2006 Jan;37(1):129-33.
2. Iso H, Stampfer MJ, Manson JE, et al. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women. Circulation. 2001 Feb 13;103(6):856-63.
Iso H, Sato S, Kitamura A, et al. Fat and protein intakes and risk of intraparenchymal hemorrhage among middle-aged Japanese. Am J Epidemiol. 2003 Jan 1;157(1):32-9.
Yano K, Reed DM, MacLean CJ. Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke. 1989 Nov;20(11):1460-5.