title: Gamma-glutamyltransferase and risk of stroke: the EUROSTROKE project.
abstract: BACKGROUND
  Alcohol consumption has been implicated in the aetiology of stroke. As data on alcohol consumption obtained by questionnaire are susceptible to misclassification, this study evaluated the association between gamma-glutamyltransferase (gamma-GT), as a marker for alcohol consumption, and fatal, non-fatal, haemorrhagic and ischaemic stroke in three European cohort studies, participating in EUROSTROKE.
  
  
  METHODS
  EUROSTROKE is a collaborative project among ongoing European cohort studies on incidence and risk factors of stroke. EUROSTROKE is designed as a nested case-control study. For each stroke case, two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. At present, data on stroke and gamma-GT were available from cohorts in Cardiff (57 cases), Kuopio (66 cases), and Rotterdam (108 cases).
  
  
  RESULTS
  An increase in gamma-GT of one standard deviation (28.7 IU/ml) was associated with an age and sex adjusted 26% (95% CI 5 to 53) increase in risk of stroke. Adjustment for confounding variables such as drug use, history of myocardial infarction, total cholesterol, and diabetes mellitus did not materially attenuate the association. The risk of haemorrhagic stroke increased linearly with increase in gamma-GT. The association for cerebral infarction was not graded: the risk increased beyond the first quartile, and remained increased. The association of gamma-GT with stroke was significantly stronger among subjects without diabetes mellitus compared with subjects with diabetes mellitus (no association observed).
  
  
  CONCLUSIONS
  This EUROSTROKE analysis showed that an increased gamma-GT, as a marker of alcohol consumption, is associated with increased risk of stroke, in particular haemorrhagic stroke.
authors.affiliation: Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands. M.L.Bots@jc.azu.nl
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: J T
authors.initials: JT
authors.lastname: Salonen
authors.forename: P C
authors.initials: PC
authors.lastname: Elwood
authors.forename: Y
authors.initials: Y
authors.lastname: Nikitin
authors.forename: A
authors.initials: A
authors.lastname: Freire de Concalves
authors.forename: D
authors.initials: D
authors.lastname: Inzitari
authors.forename: J
authors.initials: J
authors.lastname: Sivenius
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: P J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000097:blood / Q000150:complications* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000401:mortality; D004796:Clinical Enzyme Tests; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase