α‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis

Stroke remains a leading cause of disability and mortality worldwide, and the preventive role of antioxidants is of great clinical interest. The present study aimed to clarify the relationship between circulating α‑tocopherol and stroke by performing a meta‑analysis of prospective studies. The Web of Knowledge, Embase, Scopus, Cochrane Library and PubMed databases were searched through January 2026 for relevant studies. Risk ratios (RRs) and the corresponding 95% confidence intervals (CIs) were extracted to estimate the association of circulating α‑tocopherol with stroke risk. In total, six cohort studies involving 104,209 participants and 2,194 events were identified. The results indicated that a high circulating α‑tocopherol level was associated with a 22% lower stroke risk (RR, 0.78; 95% CI, 0.70‑0.87). Additionally, a higher circulating α‑tocopherol level was associated with a reduced stroke risk in the ischemic stroke (RR, 0.80; 95% CI, 0.72‑0.90), body mass index >25 (RR, 0.80; 95% CI, 0.72‑0.89), physical activity adjusted (RR, 0.69; 95% CI, 0.57‑0.84) and physical activity not adjusted (RR, 0.83; 95% CI, 0.73‑0.94) subgroups, but not for the hemorrhagic stroke (RR, 0.65; 95% CI, 0.41‑1.01) subgroup. Dose‑response analysis indicated that each 5 mg/l increment in circulating α‑tocopherol was associated with an average 8% lower stroke risk (RR, 0.92; 95% CI, 0.85‑0.98). In conclusion, the findings of the present meta‑analysis indicates that an increased circulating α‑tocopherol level may be related to lower ischemic but not hemorrhagic stroke risk. Notably, while physical activity is a critical determinant of stroke risk, the protective association of α‑tocopherol remains significant and is further strengthened after accounting for this factor. This suggests that α‑tocopherol may play a vital role in stroke prevention, particularly within the context of active lifestyle management.