Alcohol for stroke prevention?

Alcohol and Hemorrhagic Stroke in Santiago, Chile

BACKGROUND AND PURPOSE

Hemorrhagic stroke (HS) is a major cause of disability and death worldwide. There is a dearth of information on HS from geographically defined populations in Latin America. In this study we assessed the importance of alcohol consumption as a risk factor for HS in Chile.

METHODS

Case-control study in Santiago, Chile, of 140 consecutive patients with CT-confirmed HS, matched by sex and age with 140 hospital controls. Alcohol consumption was measured in grams (ethanol) per week, using a questionnaire administered to the patients or caregivers or both. We defined four categories of alcohol consumption: nondrinkers (0.0 g/week), light (0.1-115 g/week), moderate (116-402.5 g/week) and heavy drinkers (>402.5 g/week). Other variables measured included diabetes mellitus (DM), cigarette smoking, arterial hypertension, liver disease and chronic use of nonsteroidal anti-inflammatory drugs (NSAID). Statistical analysis was performed with STATA 6.0 software.

RESULTS

A total of 280 subjects with a mean age of 65.5 years were studied over a 3-year period, 122 men (43.5%) and 158 women (56.5%). Alcohol intake was 394.1 g/week among cases and 174.5 g/week in controls (p=0.01). The following odds ratios (OR) with 95% confidence intervals (CI) were found: hypertension 4.89 (2.86-10.3) and chronic use of NSAID 3.44 (2.15-12.9). Using conditional logistic regression analysis high alcohol intake was found to have a statistically significant OR of 4.47 (CI 1.14-17.2).

CONCLUSIONS

In Chile, a high alcohol intake (>402.5 g/week) increased more than 4 times the risk of HS and remained a significant risk factor for HS after controlling for hypertension, cigarette smoking, liver disease, blood cholesterol levels, and chronic use of NSAID. The risk was higher in younger patients (<65 years of age).

Antithrombotic effect of polyphenols in experimental models: a mechanism of reduced vascular risk by moderate wine consumption

Epidemiological studies have suggested that cardiovascular disease can be decreased by moderate wine consumption, but an overall quantitative estimation of the relationship between wine intake and vascular risk is lacking. A meta-analysis was therefore performed on 19 studies selected on the basis of the availability of specific information on the cardiovascular relative risk (RR) associated with wine consumption. A significant risk reduction (RR: 0.66, 95% CI 0.57-0.75) was associated with moderate (1-2 drinks or 150-300 mL/d) versus no wine consumption. In five studies which excluded ex-drinkers as reference group, the overall RR associated with wine consumption was 0.61 (95% CI 0.57-0.75). A dose-response relation between wine intake and vascular risk resulted in a J-shaped curve, with a significant risk reduction at about 300 mL/d (trend analysis p = 0.032). Two studies were also performed to investigate the effects of wine polyphenols on experimental thrombosis in rats. Supplementation for 10 days with alcohol-free red wine--but not white wine or alcohol--induced a significant reduction of stasis-induced venous thrombosis, an effect blunted by NO synthase inhibitor L-NAME. In rats with diet-induced hyperlipidemia, alcohol-free red wine supplementation significantly delayed the thrombotic occlusion of an artificial prosthesis inserted into the abdominal aorta, but did not affect the increased cholesterol and triglyceride levels. TRAP values were significantly higher in animals receiving alcohol-free wine. Altogether these experimental data support an antithrombotic role of polyphenols in the reduced vascular risk associated with moderate wine consumption in man, as shown by our epidemiological studies.

Moderate alcohol intake is associated with survival in the elderly: the Dubbo Study

OBJECTIVE

To examine the relationship between alcohol intake and survival in elderly people.

DESIGN AND SETTING

A prospective study over 116 months of non-institutionalised subjects living in Dubbo, a rural town (population, 34,000) in New South Wales.

PARTICIPANTS

1235 men and 1570 women aged 60 years and over who were first examined in 1988-89.

MAIN OUTCOME MEASURES

All-causes mortality; gross cost of alcohol per life-year gained.

RESULTS

Death occurred in 450 men and 392 women. Intake of alcohol was generally moderate (i.e., less than 14 drinks/week). Any intake of alcohol was associated with reduced mortality in men up to 75 years and in women over 64 years. In a proportional hazards model, the hazard ratio for mortality in men taking any alcohol was 0.63 (95% CI, 0.47-0.84) and in women was 0.75 (95% CI, 0.60-0.94). Cardiovascular deaths in men were reduced from 20/100 (95% CI, 14-26) to 11/100 (95% CI, 9-13) and in women from 16/100 (95% CI, 13-19) to 8/100 (95% CI, 6-10). The reduction in mortality occurred in men and women taking only 1-7 drinks/week--hazard ratios, 0.68 (95% CI, 0.49-0.94) and 0.78 (95% CI, 0.61-0.99), respectively, with a similar protective effect from intake of beer or other forms of alcohol. After almost 10 years' follow-up, men taking any alcohol lived on average 7.6 months longer, and women on average 2.7 months longer, compared with non-drinkers. The gross cost for alcohol per life-year gained if consuming 1-7 drinks/week was $5700 in men, and $19,000 in women.

CONCLUSIONS

Moderate alcohol intake in the elderly appears to be associated with significantly longer survival in men 60-74 years and in all elderly women.