Stroke: moderate alcohol consumption decreased the risk of cerebral infarction and increased the risk of subarachnoid haemorrhage in women.

Clinical bottom line (level 1b)

  1. Less than 1% of women aged 34 to 59 years had a stroke at 10 years.
  2. About half of the strokes occurring in women aged 34 to 59 years were cerebral infarctions.
  3. Women were at a decreased risk of cerebral stroke if they had an alcohol intake of 1.5 to 14.9 g per day.
  4. About a quarter of the strokes occurring in women aged 35 to 59 years were subarachnoid haemorrhages.
  5. Women were at an increased risk of subarachnoid haemorrhage if they had a daily alcohol intake of 5.0-14.9 g per day.
Stampfer et al: New England Journal of Medicine 1988; 319: 267-273
Expires December 2002

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: population based, USA

87526 patients (aged range 34 to 59 years, 100% female) female registered nurses

Excluded if
  • left 10 or more items unanswered
  • unrealistic total food scores
  • history of cancer (except skin cancer other than melanoma), angina, MI or stroke



    • Factors studied:
  • stroke, cerebral infarction, subarachnoid haemorrhage
  • 1.5-4.9 g alcohol per day
  • 5.0-14.9 g alcohol per day
  • 5.0-14.9 g alcohol per day




    • Proportional hazards models were used to adjust for confounding factors.

    98% followed for 10 years
    Outcomes studied:
  • stroke (typical neurological deficit of sudden or rapid onset and lasting at least 24 hours, and attributable to a cerebrovascular event)
  • cerebral infarction (classified according to the National Survey of Stroke)
  • subarachnoid haemorrhage
  • death due to coronary disease

    • Nurses had to fill out a questionnaire concerning food and alcohol consumption. They were asked whether consumption had greatly increased or decreases during the previous 10 years. Beer (12 oz (360 ml) can or bottle), wine (4 oz (120 ml) glass) and liquor (one standard drink) were included as separate items, and beer was assumed to contain 13.2 g of alcohol, wine 10.8 g and liquor 15.1 g.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    stroke 10 years 120/87256 0.14%
    (0.11% to 0.16%)
    cerebral infarction 10 years 66/87256 0.08%
    (0.06% to 0.09%)
    subarachnoid haemorrhage 10 years 28/87256 0.03%
    (0.02% to 0.04%)
    death due to coronary disease 10 years 36/87256 0.04%
    (0.03% to 0.05%)

    prognostic factor for
    cerebral infarction     		time to outcome adjusted RR
    (95% CI)
    1.5-4.9 g alcohol per day 10 years 0.40
    (0.20 to 0.90)
    5.0-14.9 g alcohol per day 10 years 0.30
    (0.10 to 0.70)

    prognostic factor for
    subarachnoid haemorrhage     		time to outcome adjusted RR
    (95% CI)
    5.0-14.9 g alcohol per day 10 years 3.70
    (1.00 to 13.8)

    Comments

    1. If an alcoholic beverage category on the questionnaire was left blank, the woman was considered to be a nondrinker of that beverage.

    Citation

    1. Stampfer MJ, Colditz GA, Willett WC, et al: A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. New England Journal of Medicine 1988; 319: 267-273
    Contributor: Clare Wotton and Bob Phillips, December 1999
    Reviewer:

    Clinical Question.
    Patient women
    Intervention or Exposure moderate alcohol consumption
    Comparison no alcohol consumption
    Outcome risk of coronary artery disease and stroke