Alcohol use and risk of ischemic stroke among older adults: the cardiovascular health study

Stroke. 2005 Sep;36(9):1830-4. doi: 10.1161/01.STR.0000177587.76846.89. Epub 2005 Aug 4.


Background and purpose: The association of light to moderate alcohol consumption with risk of ischemic stroke remains uncertain, as are the roles of potentially mediating factors and modification by apolipoprotein E (apoE) genotype.

Methods: We studied the prospective association of alcohol consumption and risk of ischemic stroke among 4410 participants free of cardiovascular disease at baseline in the Cardiovascular Health Study, a population-based cohort study of older adults from 4 US communities. Participants reported their consumption of alcoholic beverages yearly.

Results: During an average follow-up period of 9.2 years, 434 cases of incident ischemic stroke occurred. Compared with long-term abstainers, the multivariate relative risks of ischemic stroke were 0.85 (95% CI, 0.63 to 1.13), 0.75 (95% CI, 0.53 to 1.06), 0.82 (95% CI, 0.51 to 1.30), and 1.03 (95% CI, 0.68 to 1.57) among consumers of <1, 1 to 6, 7 to 13, and > or =14 drinks per week (P quadratic trend 0.06). ApoE genotype appeared to modify the alcohol-ischemic stroke relationship (P interaction 0.08), with generally lower risks among drinkers than abstainers in apoE4-negative participants but higher risks among drinkers than abstainers among apoE4-positive participants. We could not identify candidate mediators among lipid, inflammatory, and prothrombotic factors.

Conclusions: In this study of older adults, the association of alcohol use and risk of ischemic stroke was U-shaped, with modestly lower risk among consumers of 1 to 6 drinks per week. However, apoE genotype may modify this association, and even moderate alcohol intake may be associated with an increased risk of ischemic stroke among apoE4-positive older adults.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Alcohol Drinking / adverse effects*
  • Apolipoproteins E / genetics
  • Brain Infarction / pathology
  • Brain Ischemia / epidemiology*
  • Brain Ischemia / etiology*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Genetic Predisposition to Disease
  • Genotype
  • Humans
  • Hypertension / genetics
  • Inflammation
  • Ischemia / pathology
  • Lipids / chemistry
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction
  • Prospective Studies
  • Risk
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / etiology*
  • Substance-Related Disorders / complications
  • Thrombosis
  • Time Factors
  • Vascular Diseases / etiology*


  • Apolipoproteins E
  • Lipids