The Protective Effect of Moderate Alcohol Consumption on Ischemic Stroke

Sacco, Ralph L. MD, S
Elkind, Mitchell MD
Boden-Albala, Bernadette MPH
Lin, I-Feng MS
Kargman, Douglas E. MD, S
Hauser, W. Allen MD
Shea, Steven MD, S
Paik, Myunghee C. PhD

Department of Neurology (Drs Sacco, Elkind, Kargman, and Hauser and Mss Boden-Albala and Lin), Sergievsky Center (Drs Sacco and Hauser), Division of General Medicine, Department of Medicine (Dr Shea), Columbia University College of Physicians and Surgeons, and the Division of Epidemiology (Drs Sacco, Hauser, and Shea), Division of Socio-Medical Science (Ms Boden-Albala), and Division of Biostatistics (Ms Lin and Dr Paik), Columbia University School of Public Health, New York, NY.

JAMA: The Journal of the American Medical Association 281(1):p 53-60, January 6, 1999.

Context

Moderate alcohol consumption has been shown to be protective for coronary heart disease, but the relationship between moderate alcohol consumption and ischemic stroke is more controversial.

Objective

To determine the association between alcohol consumption and risk of ischemic stroke.

Design

Population-based case-control study conducted between July 1993 and June 1997.

Setting

Multiethnic population in northern Manhattan, New York, NY, aged 40 years or older.

Patients and Other Participants

Cases (n=677) had first ischemic stroke and were matched to community controls (n=1139) derived through random digit dialing by age, sex, and race/ethnicity. Mean +/- SD age of cases was 70.0 +/- 12.7 years; 55.8% were women; 19.5% were white, 28.4% black, and 50.7% Hispanic.

Main Outcome Measure

First ischemic stroke (fatal or nonfatal).

Results

Moderate alcohol consumption, up to 2 drinks per day, was significantly protective for ischemic stroke after adjustment for cardiac disease, hypertension, diabetes, current smoking, body mass index, and education (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.39-0.67). This protective effect of alcohol consumption was detected in both younger and older groups, in men and women, and in whites, blacks, and Hispanics. In a quadratic model of stroke risk, increased risk of ischemic stroke was statistically significant among those consuming 7 or more drinks per day (OR, 2.96; 95% CI, 1.05-8.29).

Conclusions

Moderate alcohol consumption was independently associated with a decreased risk of ischemic stroke in our elderly, multiethnic, urban subjects, while heavy alcohol consumption had deleterious effects. Our data support the National Stroke Association Stroke Prevention Guidelines regarding the beneficial effects of moderate alcohol consumption.

JAMA.1999;281:53-60