Alcohol consumption and risk of stroke: a meta-analysis.

CONTEXT Observational studies suggest that heavy alcohol consumption may increase the risk of stroke while moderate consumption may decrease the risk. OBJECTIVE To examine the association between alcohol consumption and relative risk of stroke. DATA SOURCES Studies published in English-language journals were retrieved by searching MEDLINE (1966-April 2002) using Medical Subject Headings alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke; Dissertation Abstracts Online using the keywords stroke and alcohol; and bibliographies of retrieved articles. STUDY SELECTION From 122 relevant retrieved reports, 35 observational studies (cohort or case control) in which total stroke, ischemic stroke, or hemorrhagic (intracerebral or total) stroke was an end point; the relative risk or relative odds and their variance (or data to calculate them) of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and abstainers served as the reference group. DATA EXTRACTION Information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, and risk estimates was abstracted independently by 3 investigators using a standardized protocol. DATA SYNTHESIS A random-effects model and meta-regression analysis were used to pool data from individual studies. Compared with abstainers, consumption of more than 60 g of alcohol per day was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke. CONCLUSIONS These results indicate that heavy alcohol consumption increases the relative risk of stroke while light or moderate alcohol consumption may be protective against total and ischemic stroke.

[1]  E. Beghi,et al.  Cerebrovascular disorders and alcohol intake: preliminary results of a case-control study , 1992, The Italian Journal of Neurological Sciences.

[2]  Brett M. Kissela,et al.  Subarachnoid Hemorrhage: A Preventable Disease With a Heritable Component , 2002, Stroke.

[3]  R. D'Agostino,et al.  Alcohol Consumption and Risk of Ischemic Stroke: The Framingham Study , 2002, Stroke.

[4]  D. Altmann,et al.  Exploring the relationship between alcohol consumption and non-fatal or fatal stroke: a systematic review. , 2001, Addiction.

[5]  D. Malone,et al.  Excessive antibiotic use for acute respiratory infections in the United States. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  G. Friedman,et al.  Alcohol drinking and risk of hospitalization for ischemic stroke. , 2001, The American journal of cardiology.

[7]  Richard F. Macko,et al.  Alcohol Intake, Type of Beverage, and the Risk of Cerebral Infarction in Young Women , 2001, Stroke.

[8]  M. Marmot,et al.  Alcohol and coronary heart disease. , 1984, International journal of epidemiology.

[9]  P. Schnohr,et al.  [The Copenhagen City Heart Study. Joggers live longer]. , 2000, Lakartidningen.

[10]  P. Jousilahti,et al.  Serum gamma-glutamyl transferase, self-reported alcohol drinking, and the risk of stroke. , 2000, Stroke.

[11]  H. Kulkarni,et al.  Risk factors for haemorrhagic stroke: a case-control study. , 2000, Public health.

[12]  D. Mikhailidis,et al.  Beneficial effect of moderate alcohol consumption on vascular disease: myth or reality? , 2000, The journal of the Royal Society for the Promotion of Health.

[13]  J. Manson,et al.  Light-to-moderate alcohol consumption and mortality in the Physicians' Health Study enrollment cohort. , 2000, Journal of the American College of Cardiology.

[14]  J. Buring,et al.  Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. , 1999, The New England journal of medicine.

[15]  S. Juvela,et al.  Recent heavy drinking of alcohol and embolic stroke. , 1999, Stroke.

[16]  A. Romelsjö,et al.  Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men , 1999, BMJ.

[17]  D. Albanes,et al.  Alcohol consumption and stroke incidence in male smokers. , 1999, Circulation.

[18]  C. Lasheras,et al.  Alcohol and stroke: a community case-control study in Asturias, Spain. , 1999, Journal of clinical epidemiology.

[19]  G. Davey Smith,et al.  Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up , 1999, BMJ.

[20]  J. McNeil,et al.  Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral hemorrhage. , 1999, Epidemiology.

[21]  J. Steiner,et al.  Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. , 1999, JAMA.

[22]  N L Greengold,et al.  Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. , 1999, JAMA.

[23]  W. Hauser,et al.  The Protective Effect of Moderate Alcohol Consumption on Ischemic Stroke , 1999 .

[24]  A. Klatsky.  Alcohol and cardiovascular diseases: a historical overview. , 2002, Novartis Foundation symposium.

[25]  T. Truelsen,et al.  Intake of beer, wine, and spirits and risk of stroke : the copenhagen city heart study. , 1998, Stroke.

[26]  L. Kolonel,et al.  Alcohol Intake, Body Weight, and Mortality in a Multiethnic Prospective Cohort , 1998, Epidemiology.

[27]  S. Wannamethee,et al.  Alcohol, Coronary Heart Disease and Stroke: An Examination of the J-Shaped Curve , 1998, Neuroepidemiology.

[28]  C. Warlow.  Epidemiology of stroke , 1998, The Lancet.

[29]  M. Hillbom.  Alcohol consumption and stroke: benefits and risks. , 1998, Alcoholism, clinical and experimental research.

[30]  Klatsky Al.  Alcohol and cardiovascular diseases: a historical overview. , 1998 .

[31]  J. Rehm,et al.  Moderate drinking and health. Implications of recent evidence. , 1997, Canadian family physician Medecin de famille canadien.

[32]  J. Manson,et al.  Prospective study of moderate alcohol consumption and mortality in US male physicians. , 1997, Archives of internal medicine.

[33]  B. Henderson,et al.  Follow up study of moderate alcohol intake and mortality among middle aged men in Shanghai, China , 1997, BMJ.

[34]  S. Zakhari.  Alcohol and the cardiovascular system: molecular mechanisms for beneficial and harmful action. , 1997 .

[35]  S. Juvela,et al.  Lifestyle-associated risk factors for acute brain infarction among persons of working age. , 1997, Stroke.

[36]  S. Juvela,et al.  Weekend and holiday increase in the onset of ischemic stroke in young women. , 1996, Stroke.

[37]  S. Wannamethee,et al.  Patterns of alcohol intake and risk of stroke in middle-aged British men. , 1996, Stroke.

[38]  E. Rimm,et al.  Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits? , 1996, BMJ.

[39]  C. Camargo,et al.  Case-control and cohort studies of moderate alcohol consumption and stroke. , 1996, Clinica chimica acta; international journal of clinical chemistry.

[40]  V. Burke,et al.  Alcohol and hypertension--kill or cure? , 1996, Journal of human hypertension.

[41]  M. G. Verdier,et al.  Alcohol consumption and stroke mortality. 20-year follow-up of 15,077 men and women. , 1995, Stroke.

[42]  S. Juvela,et al.  Risk factors for spontaneous intracerebral hemorrhage. , 1995, Stroke.

[43]  E. Beghi,et al.  Stroke and alcohol intake in a hospital population. A case-control study. , 1995, Stroke.

[44]  J. Webster,et al.  Alcohol intake and cardiovascular mortality in hypertensive patients: report from the Department of Health Hypertension Care Computing Project , 1995, Journal of hypertension.

[45]  H. Iso,et al.  Alcohol intake and the risk of cardiovascular disease in middle-aged Japanese men. , 1995, Stroke.

[46]  M. Fujishima,et al.  The impact of alcohol and hypertension on stroke incidence in a general Japanese population. The Hisayama Study. , 1995, Stroke.

[47]  M. Kaste,et al.  Recent alcohol consumption, cigarette smoking, and cerebral infarction in young adults. , 1995, Stroke.

[48]  C M Burchfiel,et al.  A Prospective Study of the Health Effects of Alcohol Consumption in Middle‐Aged and Elderly Men: The Honolulu Heart Program , 1994, Circulation.

[49]  C. Anderson,et al.  The Role of Lifestyle Factors in the Etiology of Stroke: A Population‐Based Case‐Control Study in Perth, Western Australia , 1994, Stroke.

[50]  M. Kaste,et al.  Regular Light‐to‐Moderate Intake of Alcohol and the Risk of Ischemic Stroke: Is There a Beneficial Effect? , 1993, Stroke.

[51]  D. Bates,et al.  Alcohol and Stroke: A Case‐Control Study of Drinking Habits Past and Present , 1993, Stroke.

[52]  G. Beevers,et al.  The relation of alcohol consumption to cardiovascular risk factors and stroke. The west Birmingham stroke project. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[53]  M. Maclure.  Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. , 1993, Epidemiologic reviews.

[54]  P. Gorelick,et al.  Alcohol as a risk factor for stroke. , 1992, Heart disease and stroke : a journal for primary care physicians.

[55]  M. Marmot,et al.  Stroke Risk From Alcohol Consumption Using Different Control Groups , 1992, Stroke.

[56]  S. Greenland,et al.  Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. , 1992, American journal of epidemiology.

[57]  P. Sleight,et al.  Publication bias , 1991, The Lancet.

[58]  P. Macfarlane,et al.  Risk factors for stroke in middle aged British men. , 1991, BMJ.

[59]  Edward M. Hitchcock,et al.  Alcohol consumption--a risk factor for hemorrhagic and non-hemorrhagic stroke. , 1991, The American journal of medicine.

[60]  G. Friedman,et al.  Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. , 1990, The American journal of cardiology.

[61]  R. Estruch,et al.  High ethanol consumption as risk factor for intracerebral hemorrhage in young and middle-aged people. , 1990, Stroke.

[62]  C. Turner,et al.  How much alcohol is in a 'standard drink'? An analysis of 125 studies. , 1990, British journal of addiction.

[63]  M. Kaste,et al.  Alcohol abuse and brain infarction. , 1990, Annals of medicine.

[64]  R. Horwitz,et al.  Evidence against the association between alcohol use and ischemic stroke risk. , 1989, Archives of internal medicine.

[65]  G. Friedman,et al.  Alcohol use and subsequent cerebrovascular disease hospitalizations. , 1989, Stroke.

[66]  Daniel B Hier,et al.  Weekly alcohol consumption, cigarette smoking, and the risk of ischemic stroke , 1989, Neurology.

[67]  A. G. Shaper,et al.  ALCOHOL AND MORTALITY IN BRITISH MEN: EXPLAINING THE U-SHAPED CURVE , 1988, The Lancet.

[68]  M. Shipley,et al.  A community case-control study of alcohol consumption in stroke. , 1988, International Journal of Epidemiology.

[69]  W. Willett,et al.  A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. , 1988, The New England journal of medicine.

[70]  A. G. Shaper,et al.  Men who do not drink: a report from the British Regional Heart Study. , 1988, International journal of epidemiology.

[71]  E. Eichner.  Alcohol, stroke and coronary artery disease. , 1988, American family physician.

[72]  T. Gordon,et al.  DRINKING AND MORTALITY THE ALBANY STUDY , 1987 .

[73]  D. Beevers,et al.  Stroke and alcohol consumption. , 1986, The New England journal of medicine.

[74]  S. Kono,et al.  Alcohol and mortality: a cohort study of male Japanese physicians. , 1986, International journal of epidemiology.

[75]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[76]  D. Reed,et al.  Alcohol and hemorrhagic stroke. The Honolulu Heart Program. , 1986, JAMA.

[77]  B Herman,et al.  Multivariate logistic analysis of risk factors for stroke in Tilburg, The Netherlands. , 1983, American journal of epidemiology.

[78]  A. Siegelaub,et al.  Alcohol and mortality. A ten-year Kaiser-Permanente experience. , 1981, Annals of internal medicine.

[79]  K. Yano,et al.  Alcohol and mortality: the Honolulu Heart Study. , 1980, The American journal of medicine.

[80]  J. Popper,et al.  Factors Related to Stroke Incidence in Hawaii Japanese Men: The Honolulu Heart Study , 1980, Stroke.

[81]  A. Belanger,et al.  The Framingham study. , 1976, British medical journal.

[82]  F. Browne.  Young Women , 1948 .