Alcohol use and risk of ischemic stroke among older adults: the cardiovascular health study.
OBJECTIVE
The association of light to moderate alcohol consumption with risk of ischemic stroke remains uncertain, as are the roles of potentially mediating factors and modification by apolipoprotein E (apoE) genotype.


METHODS
We studied the prospective association of alcohol consumption and risk of ischemic stroke among 4410 participants free of cardiovascular disease at baseline in the Cardiovascular Health Study, a population-based cohort study of older adults from 4 US communities. Participants reported their consumption of alcoholic beverages yearly.


RESULTS
During an average follow-up period of 9.2 years, 434 cases of incident ischemic stroke occurred. Compared with long-term abstainers, the multivariate relative risks of ischemic stroke were 0.85 (95% CI, 0.63 to 1.13), 0.75 (95% CI, 0.53 to 1.06), 0.82 (95% CI, 0.51 to 1.30), and 1.03 (95% CI, 0.68 to 1.57) among consumers of <1, 1 to 6, 7 to 13, and > or =14 drinks per week (P quadratic trend 0.06). ApoE genotype appeared to modify the alcohol-ischemic stroke relationship (P interaction 0.08), with generally lower risks among drinkers than abstainers in apoE4-negative participants but higher risks among drinkers than abstainers among apoE4-positive participants. We could not identify candidate mediators among lipid, inflammatory, and prothrombotic factors.


CONCLUSIONS
In this study of older adults, the association of alcohol use and risk of ischemic stroke was U-shaped, with modestly lower risk among consumers of 1 to 6 drinks per week. However, apoE genotype may modify this association, and even moderate alcohol intake may be associated with an increased risk of ischemic stroke among apoE4-positive older adults.
Mukamal
Kenneth J
KJ
Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. kmukamal@bidmc.harvard.edu
Chung
Hyoju
H
Jenny
Nancy S
NS
Kuller
Lewis H
LH
Longstreth
W T
WT
Mittleman
Murray A
MA
Burke
Gregory L
GL
Cushman
Mary
M
Beauchamp
Norman J
NJ
Siscovick
David S
DS
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001057:Apolipoproteins E / Q000235:genetics; D020520:Brain Infarction / Q000473:pathology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000235:genetics; D007249:Inflammation; D007511:Ischemia / Q000473:pathology; D008055:Lipids / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D019966:Substance-Related Disorders / Q000150:complications; D013927:Thrombosis; D013997:Time Factors; D014652:Vascular Diseases / Q000209:etiology*
D001057:Apolipoproteins E; D008055:Lipids