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Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Background: Whether light-to-moderate alcohol consumption is protective against stroke, and whether any association differs by stroke type, is controversial. We conducted a meta-analysis to summarize the evidence from prospective studies on alcohol drinking and stroke types.

Methods: Studies were identified by searching PubMed to September 1, 2016, and reference lists of retrieved articles. Additional data from 73,587 Swedish adults in two prospective studies were included. Study-specific results were combined in a random-effects model.

Results: The meta-analysis included 27 prospective studies with data on ischemic stroke (25 studies), intracerebral hemorrhage (11 studies), and/or subarachnoid hemorrhage (11 studies). Light and moderate alcohol consumption was associated with a lower risk of ischemic stroke, whereas high and heavy drinking was associated with an increased risk; the overall RRs were 0.90 (95 % CI, 0.85–0.95) for less than 1 drink/day, 0.92 (95 % CI, 0.87–0.97) for 1–2 drinks/day, 1.08 (95 % CI, 1.01–1.15) for more than 2–4 drinks/day, and 1.14 (95 % CI, 1.02–1.28) for more than 4 drinks/day. Light and moderate alcohol drinking was not associated with any hemorrhagic stroke subtype. High alcohol consumption (>2–4 drinks/day) was associated with a non-significant increased risk of both hemorrhagic stroke subtypes, and the relative risk for heavy drinking (>4 drinks/day) were 1.67 (95 % CI, 1.25–2.23) for intracerebral hemorrhage and 1.82 (95 % CI, 1.18–2.82) for subarachnoid hemorrhage.

Conclusion: Light and moderate alcohol consumption was inversely associated only with ischemic stroke, whereas heavy drinking was associated with increased risk of all stroke types with a stronger association for hemorrhagic strokes.

Electronic supplementary material: The online version of this article (doi:10.1186/s12916-016-0721-4) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Overall relative risks (RR) with 95 % confidence intervals (CI) for the associations of alcohol consumption (average number of drinks per day) with risk of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. *Number of studies that contributed data to each category of alcohol consumption and stroke type. I2 values < 30 %, 30–75 %, and > 75 % were interpreted as no or low heterogeneity, moderate heterogeneity, and notable heterogeneity, respectively
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Fig1: Overall relative risks (RR) with 95 % confidence intervals (CI) for the associations of alcohol consumption (average number of drinks per day) with risk of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. *Number of studies that contributed data to each category of alcohol consumption and stroke type. I2 values < 30 %, 30–75 %, and > 75 % were interpreted as no or low heterogeneity, moderate heterogeneity, and notable heterogeneity, respectively

Mentions: The associations between levels of alcohol consumption and stroke types are presented in Fig. 1. Light and moderate alcohol consumption (up to 2 drinks/day) was associated with a reduced risk of ischemic stroke, whereas high and heavy alcohol consumption (> 2 drinks/day) was associated with an increased risk. The overall RRs (95 % CI) of ischemic stroke were 0.90 (95 % CI, 0.85–0.95) for less than 1 drink/day, 0.92 (95 % CI, 0.87–0.97) for 1–2 drinks/day, 1.08 (95 % CI, 1.01–1.15) for more than 2–4 drinks/day, and 1.14 (95 % CI, 1.02–1.28) for more than 4 drinks/day, with low between-study heterogeneity in all categories (I2 ≤ 23.7 %). When the lowest category was split into 3 or less drinks/week and more than 3–7 drinks/week, the overall RRs were 0.89 (95 % CI, 0.84–0.94; I2 = 20 %; 16 studies) and 0.90 (95 % CI, 0.83–0.98; I2 = 23.6 %; 19 studies), respectively. There were no overall associations of light and moderate alcohol consumption (up to 2 drinks/day) with risk of intracerebral hemorrhage or subarachnoid hemorrhage. However, high alcohol consumption (> 2–4 drinks/day) was associated with a non-statistically significant increased risk of both hemorrhagic stroke subtypes and heavy alcohol consumption (> 4 drinks/day) was associated with a statistically significant increased risk of both intracerebral hemorrhage (RR = 1.67; 95 % CI, 1.25–2.23) and subarachnoid hemorrhage (RR = 1.82; 95 % CI, 1.18–2.82). There was low to moderate heterogeneity among study-specific results for hemorrhagic stroke subtypes. Results did not change in a sensitivity analysis in which the mid-point for the highest category was set at 1.5 times the half range of the preceding category.Fig. 1


Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis
Overall relative risks (RR) with 95 % confidence intervals (CI) for the associations of alcohol consumption (average number of drinks per day) with risk of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. *Number of studies that contributed data to each category of alcohol consumption and stroke type. I2 values < 30 %, 30–75 %, and > 75 % were interpreted as no or low heterogeneity, moderate heterogeneity, and notable heterogeneity, respectively
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121939&req=5

Fig1: Overall relative risks (RR) with 95 % confidence intervals (CI) for the associations of alcohol consumption (average number of drinks per day) with risk of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. *Number of studies that contributed data to each category of alcohol consumption and stroke type. I2 values < 30 %, 30–75 %, and > 75 % were interpreted as no or low heterogeneity, moderate heterogeneity, and notable heterogeneity, respectively
Mentions: The associations between levels of alcohol consumption and stroke types are presented in Fig. 1. Light and moderate alcohol consumption (up to 2 drinks/day) was associated with a reduced risk of ischemic stroke, whereas high and heavy alcohol consumption (> 2 drinks/day) was associated with an increased risk. The overall RRs (95 % CI) of ischemic stroke were 0.90 (95 % CI, 0.85–0.95) for less than 1 drink/day, 0.92 (95 % CI, 0.87–0.97) for 1–2 drinks/day, 1.08 (95 % CI, 1.01–1.15) for more than 2–4 drinks/day, and 1.14 (95 % CI, 1.02–1.28) for more than 4 drinks/day, with low between-study heterogeneity in all categories (I2 ≤ 23.7 %). When the lowest category was split into 3 or less drinks/week and more than 3–7 drinks/week, the overall RRs were 0.89 (95 % CI, 0.84–0.94; I2 = 20 %; 16 studies) and 0.90 (95 % CI, 0.83–0.98; I2 = 23.6 %; 19 studies), respectively. There were no overall associations of light and moderate alcohol consumption (up to 2 drinks/day) with risk of intracerebral hemorrhage or subarachnoid hemorrhage. However, high alcohol consumption (> 2–4 drinks/day) was associated with a non-statistically significant increased risk of both hemorrhagic stroke subtypes and heavy alcohol consumption (> 4 drinks/day) was associated with a statistically significant increased risk of both intracerebral hemorrhage (RR = 1.67; 95 % CI, 1.25–2.23) and subarachnoid hemorrhage (RR = 1.82; 95 % CI, 1.18–2.82). There was low to moderate heterogeneity among study-specific results for hemorrhagic stroke subtypes. Results did not change in a sensitivity analysis in which the mid-point for the highest category was set at 1.5 times the half range of the preceding category.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Whether light-to-moderate alcohol consumption is protective against stroke, and whether any association differs by stroke type, is controversial. We conducted a meta-analysis to summarize the evidence from prospective studies on alcohol drinking and stroke types.

Methods: Studies were identified by searching PubMed to September 1, 2016, and reference lists of retrieved articles. Additional data from 73,587 Swedish adults in two prospective studies were included. Study-specific results were combined in a random-effects model.

Results: The meta-analysis included 27 prospective studies with data on ischemic stroke (25 studies), intracerebral hemorrhage (11 studies), and/or subarachnoid hemorrhage (11 studies). Light and moderate alcohol consumption was associated with a lower risk of ischemic stroke, whereas high and heavy drinking was associated with an increased risk; the overall RRs were 0.90 (95&nbsp;% CI, 0.85&ndash;0.95) for less than 1 drink/day, 0.92 (95&nbsp;% CI, 0.87&ndash;0.97) for 1&ndash;2 drinks/day, 1.08 (95&nbsp;% CI, 1.01&ndash;1.15) for more than 2&ndash;4 drinks/day, and 1.14 (95&nbsp;% CI, 1.02&ndash;1.28) for more than 4 drinks/day. Light and moderate alcohol drinking was not associated with any hemorrhagic stroke subtype. High alcohol consumption (&gt;2&ndash;4 drinks/day) was associated with a non-significant increased risk of both hemorrhagic stroke subtypes, and the relative risk for heavy drinking (&gt;4 drinks/day) were 1.67 (95&nbsp;% CI, 1.25&ndash;2.23) for intracerebral hemorrhage and 1.82 (95&nbsp;% CI, 1.18&ndash;2.82) for subarachnoid hemorrhage.

Conclusion: Light and moderate alcohol consumption was inversely associated only with ischemic stroke, whereas heavy drinking was associated with increased risk of all stroke types with a stronger association for hemorrhagic strokes.

Electronic supplementary material: The online version of this article (doi:10.1186/s12916-016-0721-4) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus