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(Stroke. 2005;36:1835.)
© 2005 American Heart Association, Inc.

Original Contributions

Editorial Comment—Alcohol and Stroke

An Epidemiological Labyrinth

Arthur L. Klatsky, MD

Senior Consultant in Cardiology, Kaiser Permanente Medical Care Program, Oakland, California

Key Words: epidemiology

An extract of the first 250 words of the full text is provided, because this article has no abstract.

According to the seventh edition of Webster’s New Collegiate Dictionary, the definition of labyrinth is "something extremely tortuous or complex in structure, arrangement, or character." The investigator who studies the relations of alcohol drinking to stroke chooses a tortuous path. Multiple issues need consideration. (1) Stroke is not one disease. There are disparities in risk factors of the major stroke types, hemorrhagic stroke (HS), and ischemic stroke (IS), and of their subdivisions.^1–5 (2) Several cardiovascular conditions have independent relations to alcohol drinking and also to 1 stroke types; these include systemic hypertension (HTN), dilated cardiomyopathy, atrial arrhythmias, and coronary heart disease.^6,7 (3) As always with respect to alcohol, light-moderate and heavy drinking play quite different roles. (4) Cigarette smoking, a strong adverse predictor of HS and IS, is correlated with alcohol drinking and must be carefully controlled. (5) Drinking pattern and beverage choice play a role; binge drinking, in particular, increases risk.¹ (6) Drinking habits change. (7) Nonalcohol components of specific beverages might play a role. (8) There are potential interactions of alcohol with antithrombotic treatment, perhaps especially with warfarin anticoagulation. (9) Under-reporting by heavy drinkers could produce a spuriously low threshold for harmful effects or an apparent continuous relation when a true threshold effect exists.

Considering the potentially labyrinthine interactions between these factors, it is hardly surprising that reports about alcohol and "stroke" are conflicting.

Heavy drinking (defined here as >2 standard-sized drinks per day) is related to increased prevalence of HTN,^7,8 and alcohol has antithrombotic effects.^9,10 Thus, . . . [Full Text of this Article]

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Alcohol Use and Risk of Ischemic Stroke Among Older Adults: The Cardiovascular Health Study

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Stroke 2005 36: 1830-1834. [Abstract] [Full Text] [PDF]

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