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Alcohol and Risk for Ischemic Stroke in Men: The Role of Drinking Patterns and Usual Beverage
- Kenneth J. Mukamal, MD, MPH, MA;
- Alberto Ascherio, MD, DrPH;
- Murray A. Mittleman, MD, DrPH;
- Katherine M. Conigrave, MD;
- Carlos A. Camargo, Jr, MD, DrPH;
- Ichiro Kawachi, MD, PhD;
- Meir J. Stampfer, MD, DrPH;
- Walter C. Willett, MD, DrPH; and
- Eric B. Rimm, ScD
- From Beth Israel Deaconess Medical Center, Harvard School of Public Health, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts; and University of Sydney, Sydney, and Royal Prince Alfred Hospital, Camperdown, Australia.
Abstract
Background: The association of light to moderate alcohol consumption with risk for ischemic stroke remains controversial, as do the roles of beverage type and drinking pattern.
Objective: To assess the association of drinking patterns and beverage type with risk for ischemic stroke among men.
Design: Prospective cohort study.
Setting: United States.
Participants: 38 156 male health professionals who were free of known cardiovascular disease or cancer at baseline in 1986.
Measurements: With a semi-quantitative food-frequency questionnaire, the authors individually ascertained consumption of regular and light beer, red and white wine, and liquor every 4 years. Alcohol consumption was categorized as light (0.1 to 9.9 g/d, or <1 drink daily), moderate (10.0 to 29.9 g/d, or 1 to 2 drinks daily), and heavier (≥30.0 g/d, or ≥3 drinks daily).
Results: During a follow-up period of 14 years, 412 cases of incident ischemic stroke were documented. Compared with abstainers, light drinkers had a multivariate-adjusted relative risk of 0.99 (95% CI, 0.72 to 1.37), moderate drinkers had a multivariate-adjusted relative risk of 1.26 (CI, 0.90 to 1.76), and heavier drinkers had a multivariate-adjusted relative risk of 1.42 (CI, 0.97 to 2.09; P = 0.01 for trend). Consumption of 10.0 to 29.9 g of alcohol per day on 3 to 4 days per week appeared to be associated with the lowest risk (relative risk, 0.68 [CI, 0.44 to 1.05]). Red wine consumption was inversely associated with risk in a graded manner (P = 0.02 for trend), but other beverages were not. The apparently higher risk for ischemic stroke with heavier alcohol use appeared to be most pronounced for the embolic subtype.
Limitations: This study had limited power to examine specific drinking patterns and heavy drinking and could not assess risk for hemorrhagic stroke.
Conclusions: In this sample of male health professionals, light and moderate average alcohol use was generally not associated with an increased risk for ischemic stroke, although drinking pattern and beverage type modified this relation. Intake of more than 2 drinks per day may be associated with a higher risk for ischemic stroke.
Article and Author Information
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Grant Support: By National Institutes of Health grants AA00299, AA11181, HL35464, and CA55075.
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Potential Financial Conflicts of Interest:Honoraria: E.B. Rimm.
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Requests for Single Reprints: Kenneth J. Mukamal, MD, MPH, MA, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215; e-mail, kmukamal{at}bidmc.harvard.edu.
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Current Author Addresses: Dr. Mukamal: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215.
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Drs. Ascherio, Willett, and Rimm: Department of Nutrition, Harvard School of Public Health, Building II, 655 Huntington Avenue, Boston, MA 02115.
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Dr. Mittleman: Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Dea-301, Boston, MA 02215.
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Dr. Conigrave: Drug and Alcohol Department, Royal Prince Albert Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
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Dr. Camargo: Department of Emergency Medicine, Massachusetts General Hospital, Clinics Building 397, 55 Fruit Street, Boston, MA 02114.
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Drs. Kawachi and Stampfer: Department of Epidemiology, Harvard School of Public Health, Kresge Building, 677 Huntington Avenue, Boston, MA 02115.
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Author Contributions: Conception and design: E.B. Rimm.
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Analysis and interpretation of the data: K.J. Mukamal, C.A. Camargo Jr., I. Kawachi, M.J. Stampfer.
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Drafting of the article: K.J. Mukamal, I. Kawachi.
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Critical revision of the article for important intellectual content: K.J. Mukamal, A. Ascherio, M.A. Mittleman, K.M. Conigrave, C.A. Camargo Jr., I. Kawachi, M.J. Stampfer, W.C. Willett, E.B. Rimm.
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Final approval of the article: K.J. Mukamal, C.A. Camargo Jr., M.J. Stampfer, E.B. Rimm.
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Provision of study materials or patients: E.B. Rimm.
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Statistical expertise: M.J. Stampfer.
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Obtaining of funding: K.J. Mukamal, E.B. Rimm.
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Collection and assembly of data: I. Kawachi, E.B. Rimm.
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