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Moderate consumption of alcoholic beverages and different types of stroke

01/07/2010

Among adults worldwide, stroke is the second leading cause of death and ranks fourth in overall burden of disease. Thus, stroke is an international health problem with high human and economic costs associated.

Among adults worldwide, stroke is the second leading cause of death and ranks fourth in overall burden of disease. Thus, stroke is an international health problem with high human and economic costs associated. Over the past decades, the stroke incidence and related deaths seem to be rising, particularly in economically emerging countries. Stroke is characterized by a rapid loss of brain functions due to disturbance in the blood supply to the brain. This can either be due to a lack of blood flow caused by a blockage (thrombosis or arterial embolism), which is referred to as “schemic stroke“ or due to a leakage of blood into the brain, referred to as “hemorrhagic stroke“. As a consequence of both, the affected area of the brain is unable to function. Often, this results in an inability to move one or more limbs on one side of the body, or to understand or formulate speech, or to see on one side of the face. In the Western world, ischemic stroke is the most prevalent type. For example in
Germany, 160-240 cases out of 100.000 per year die from ischemic stroke, whereas for hemorrhagic stroke, there are about 30 cases/100.000/year. Risk factors for stroke include advanced age, high blood pressure, cigarette smoking, atrial fibrillation, diabetes, high cholesterol, previous stroke or transient ischemic attack. High blood pressure is the most important modifiable risk factor of stroke. It is also well accepted that heavy consumption of alcoholic beverages increases the risk of ischemic and hemorrhagic stroke. However, several studies reported an inverse association between moderate alcohol intake and stroke indicating a preventive effect. Researchers from the University of Toronto, Canada, and the University of Dresden, Germany, carried out a meta-analysis to systematically assess the impact of alcoholic
beverages on both, the type and outcome of stroke, and to provide risk estimates based on the level of alcohol. The recently published results suggest a consistent association between heavy drinking and risk for both types of stroke. The dose response relationship for hemorrhagic stroke showed a steadily rising risk for increasing consumption. In contrast, a J-curved relationship was observed with ischemic stroke, with a protective effect of low to moderate amounts of alcohol and an increasing risk for a higher exposure. In general, with more than 3 drinks on average/day, women had a higher risk than men, and the mortality risk was higher compared to the morbidity risk. In other words: a moderate consumption of up to 3 drinks per day is protective for ischemic stroke but neutral for hemorrhagic stroke. The curvilinear relationship for ischemic stroke resembles the dose-response relationship between alcoholic beverages and ischemic heart disease with the same
underlying biological mechanisms. For hemorrhagic stroke, hypertension plays a more prominent role in the etiology since alcohol, already operant at low doses, has been identified as a major risk factor for hypertension, and might explain the different dose-response relationship. All together, these results indicate that heavy consumption of alcoholic beverages increases the relative risk of any stroke while light or moderate alcohol consumption may be protective against ischemic stroke predominant in the western world. In line with the results on the cardio-protective effect of alcohol including the evidence on biological pathways, it seems reasonable that the protective effect on ischemic stroke is limited to people who not only drink moderately, but who also avoid heavy drinking occasions.

Patra J, Taylor B, Irving H, et al. Alcohol consumption and the risk of morbidity and mortality for different
stroke types--a systematic review and meta-analysis. BMC Public Health 2010;10:258.

 

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Fivin Wine in moderation