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. 2024 Jan 12;29(1):50.
doi: 10.1186/s40001-024-01646-5.

Antioxidants and the risk of stroke: results from NHANES and two-sample Mendelian randomization study

Rundong Chen #  1   2 , Hanchen Liu #  1 , Guanghao Zhang #  1 , Qian Zhang  3 , Weilong Hua  1 , Lei Zhang  1 , Nan Lv  1 , Yilei Zhang  4 , Dongwei Dai  1 , Rui Zhao  1 , Qiang Li  1 , Qinghai Huang  1 , Yi Xu  1 , Pengfei Yang  1   2 , Jianmin Liu  5   6 , Qiao Zuo  7
Affiliations

Antioxidants and the risk of stroke: results from NHANES and two-sample Mendelian randomization study

Rundong Chen et al. Eur J Med Res. .

Abstract

Background: Stroke is the second leading cause of death worldwide, and observational studies have suggested a correlation between antioxidants and reduced stroke risk. However, it remains unclear whether causal relationships exist.

Methods: This study first performed a cross-sectional study of the association between the Composite Dietary Antioxidant Index (CDAI) and stroke using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Second, a two-sample univariable Mendelian Randomization (MR) was performed to analyze the causal effect of circulating levels of antioxidants on different subtypes of stroke.

Results: The cross-sectional study included a total of 24,892 participants representing more than 200 million US non-institutionalized residents, a multivariable logistic regression model revealed that the risk of stroke decreased by 3.4% for each unit increase in CDAI (P = 0.017), with a non-linear association found, indicating a reduction in stroke risk before an inflection point of 3.078. MR analysis revealed that genetically determined levels of retinol had a suggestive protective effect on subarachnoid hemorrhage (SAH) (OR = 0.348, P = 0.025), and genetically determined levels of selenium had a suggestive protective effect against SAH (OR = 0.826, P = 0.007). However, no causal relationship was found between antioxidants and ischemic stroke or intracranial hemorrhage risk.

Conclusions: Evidence suggests that diet-derived antioxidants may reduce the risk of stroke, as indicated by the protective effects of retinol and selenium against SAH. However, more research is needed to fully understand how antioxidants prevent stroke.

Keywords: Antioxidants; Mendelian randomization; NHANES; Retinol; Selenium; Stroke; Subarachnoid hemorrhage.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Restricted cubic spline plot of the association between CDAI and stroke. All variables are taken into account and adjusted accordingly. The shaded part represented the 95% CI. CDAI Composite Dietary Antioxidant Index, OR Odds Ratio
Fig. 2
Fig. 2
Forest plots of the association between CDAI and stroke subgroups. CDAI Composite Dietary Antioxidant Index, OR Odds ratio, CI Confidence interval
Fig. 3
Fig. 3
Forest plot for the causal effect of diet-derived antioxidant on the risk of stroke derived from inverse variance weighted (IVW). OR Odds ratio, CI Confidence interval
Fig. 4
Fig. 4
Scatter plots of Mendelian Randomization tests assessing the effect of (A) Vitamin A on SAH and (B) selenium on SAH. SAH subarachnoid hemorrhage
See this image and copyright information in PMC

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