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Article Open Access

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

  • Authors:
    • Peng Xu
    • Pengfei Cheng
  • View Affiliations / Copyright

    Affiliations: Department of Rehabilitation Medicine, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, P.R. China, Department of Neurology, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin 300100, P.R. China
    Copyright: © Xu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 158
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    Published online on: April 9, 2026
       https://doi.org/10.3892/etm.2026.13153
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Abstract

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.
View Figures

Figure 1

Flow chart of study selection. This
diagram illustrates the systematic process of literature search,
screening and the inclusion/exclusion criteria used to identify the
final studies for the meta-analysis.

Figure 2

Meta-analysis of circulating
α-tocopherol with stroke risk, ischemic stroke, and hemorrhagic
stroke risk. The forest plots present the pooled risk ratios and
95% CIs. Statistical significance was set at P<0.05. CI,
confidence interval.

Figure 3

BMI and age subgroups analyses. These
subgroup analyses evaluate whether the association between
circulating α-tocopherol and stroke risk remains consistent across
different BMI categories and age groups. Results are presented as
risk ratios (RRs) and 95% CIs. BMI, body mass index; CI, confidence
interval.

Figure 4

Follow-up duration and physical
activity subgroups analyses. These subgroup analyses evaluate
whether the association between circulating α-tocopherol and stroke
risk is influenced by the length of follow-up or adjustments for
physical activity. Results are presented as risk ratios and 95%
CIs. CI, confidence interval.

Figure 5

Circulating α-tocopherol and stroke
risk. Dose-response analysis of circulating α-tocopherol levels and
stroke risk. Summary estimates were calculated using a
random-effects model (P=0.015). The solid and long-dashed lines
represent the estimated relative risks and their 95% confidence
intervals, respectively.

Figure 6

Meta-regression plots of potential
moderators. (A) Follow-up duration (P=0.185); (B) age (P=0.942);
(C) physical activity (analyzed as a dichotomous variable: adjusted
vs. non-adjusted, P=0.133). In panel (C), the individual bubbles
for the six studies are distributed into two columns based on their
adjustment status. The size of each bubble represents the study's
weight, and the P-values indicate no statistically significant
moderating effects.

Figure 7

Leave-one-out sensitivity analysis of
the association between circulating α-tocopherol levels and stroke
risk. The vertical dashed lines represent the overall pooled RR and
its 95% CI. This plot demonstrates that no single study
significantly altered the summary results. RR, risk ratio; CI,
confidence interval.

Figure 8

Funnel plot of circulating
α-tocopherol and stroke risk. Different symbols and colors are used
to distinguish study subgroups, including BMI, physical activity,
age and follow-up duration. No significant publication bias was
detected (Egger's test, P>0.05). BMI, body mass index; RR, risk
ratio.
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Copy and paste a formatted citation
Spandidos Publications style
Xu P and Cheng P: &alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis. Exp Ther Med 31: 158, 2026.
APA
Xu, P., & Cheng, P. (2026). &alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis. Experimental and Therapeutic Medicine, 31, 158. https://doi.org/10.3892/etm.2026.13153
MLA
Xu, P., Cheng, P."&alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis". Experimental and Therapeutic Medicine 31.6 (2026): 158.
Chicago
Xu, P., Cheng, P."&alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis". Experimental and Therapeutic Medicine 31, no. 6 (2026): 158. https://doi.org/10.3892/etm.2026.13153
Copy and paste a formatted citation
x
Spandidos Publications style
Xu P and Cheng P: &alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis. Exp Ther Med 31: 158, 2026.
APA
Xu, P., & Cheng, P. (2026). &alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis. Experimental and Therapeutic Medicine, 31, 158. https://doi.org/10.3892/etm.2026.13153
MLA
Xu, P., Cheng, P."&alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis". Experimental and Therapeutic Medicine 31.6 (2026): 158.
Chicago
Xu, P., Cheng, P."&alpha;‑tocopherol in the prevention of ischemic or hemorrhagic stroke: A meta‑analysis". Experimental and Therapeutic Medicine 31, no. 6 (2026): 158. https://doi.org/10.3892/etm.2026.13153
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