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. 2023 Jan 10;100(2):e142-e153.
doi: 10.1212/WNL.0000000000201388. Epub 2022 Oct 11.

Alcohol Intake as a Risk Factor for Acute Stroke: The INTERSTROKE Study

Andrew Smyth  1 , Martin O'Donnell  2 , Sumathy Rangarajan  2 , Graeme J Hankey  2 , Shahram Oveisgharan  2 , Michelle Canavan  2 , Clodagh McDermott  2 , Denis Xavier  2 , Hongye Zhang  2 , Albertino Damasceno  2 , Alvaro Avezum  2 , Nana Pogosova  2 , Aytekin Oguz  2 , Danuta Ryglewicz  2 , Helle Klingenberg Iversen  2 , Fernando Lanas  2 , Annika Rosengren  2 , Salim Yusuf  2 , Peter Langhorne  2 ; INTERSTROKE Investigators
Collaborators, Affiliations

Alcohol Intake as a Risk Factor for Acute Stroke: The INTERSTROKE Study

Andrew Smyth et al. Neurology. .

Abstract

Background and objectives: There is uncertainty about the association between alcohol consumption and stroke, particularly for low-moderate intake. We explored these associations in a large international study.

Methods: INTERSTROKE, a case-control study, is the largest international study of risk factors for acute stroke. Alcohol consumption was self-reported and categorized by drinks/week as low (1-7), moderate (7-14 for females and 7-21 for males), or high (>14 for females and >21 for males). Heavy episodic drinking (HED) was defined as >5 drinks on ≥1 day per month. Multivariable conditional logistic regression was used to determine associations.

Results: We included 12,913 cases and 12,935 controls; 25.0% (n = 6,449) were current drinkers, 16.7% (n = 4,318) former drinkers, and 58.3% (n = 15,076) never drinkers. Current drinkers were younger, male, smokers, active, and with higher-paid occupations. Current drinking was associated with all stroke (OR 1.14; 95% CI 1.04-1.26) and intracerebral hemorrhage (ICH) (OR 1.50, 95% CI 1.21-1.84) but not ischemic stroke (OR 1.06; 95% CI 0.95-1.19). HED pattern was associated with all stroke (OR 1.39; 95% CI 1.21-1.59), ischemic stroke (OR 1.29; 95% CI 1.10-1.51), and ICH (OR 1.76; 95% CI 1.31-2.36). High level of alcohol intake was consistently associated with all stroke, ischemic stroke, and ICH. Moderate intake was associated with all stroke and ICH but not ischemic stroke. Low alcohol intake was not associated with stroke overall, but there were regional differences; low intake was associated with reduced odds of stroke in Western Europe/North America (OR 0.66; 95% CI 0.45-0.96) and increased odds in India (OR 2.18; 95% CI 1.42-3.36) (p-interaction 0.037). Wine consumption was associated with reduced odds of all stroke and ischemic stroke but not ICH. The magnitudes of association were greatest in those without hypertension and current smokers.

Discussion: High and moderate intake were associated with increased odds of stroke, whereas low intake was not associated with stroke. However, there were important regional variations, which may relate to differences in population characteristics of alcohol consumers, types or patterns of consumption.

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Figures

Figure 1
Figure 1. Alcohol Consumption by Sex and Geographic Region
(A) Frequency of never, former, and current drinking by sex and region. (B) Frequency of heavy episodic drinking within current drinkers by sex and region. (C) Frequency of low, moderate, and high intake within current drinks by sex and region. (D) Distribution of predominant alcoholic beverage consumed within current drinkers by sex and region.
Figure 2
Figure 2. Association Between Alcohol Consumption and Stroke
Conditional logistic regression adjusted for hypertension, smoking, AHEI, physical activity, diabetes, cardiac risk factors, ApoB/ApoA, age, stress with pairs matched for age, sex, and region. *Additional adjustment for age, sex, and region. Abbreviation: AEHI = Alternate Healthy Eating Index.
Figure 3
Figure 3. Propensity Score (for Current Drinking) Matched Analyses for the Association Between Alcohol Intake and All Stroke
Propensity score for current vs never drinking with adjusted for hypertension, smoking, AHEI, physical activity, diabetes, cardiac risk factors, ApoB/ApoA, and stress. *Additional adjustment for age, sex, and region. Abbreviation: AEHI = Alternate Healthy Eating Index.
See this image and copyright information in PMC

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