0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Alcohol and Risk for Ischemic Stroke in Men: The Role of Drinking Patterns and Usual Beverage

Kenneth J. Mukamal, MD, MPH, MA; Alberto Ascherio, MD, DrPH; Murray A. Mittleman, MD, DrPH; Katherine M. Conigrave, MD; Carlos A. Camargo Jr, MD, DrPH; Ichiro Kawachi, MD, PhD; Meir J. Stampfer, MD, DrPH; Walter C. Willett, MD, DrPH; and Eric B. Rimm, ScD
[+] Article and Author Information

From Beth Israel Deaconess Medical Center, Harvard School of Public Health, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts; and University of Sydney, Sydney, and Royal Prince Alfred Hospital, Camperdown, Australia.


Grant Support: By National Institutes of Health grants AA00299, AA11181, HL35464, and CA55075.

Potential Financial Conflicts of Interest:Honoraria: E.B. Rimm.

Requests for Single Reprints: Kenneth J. Mukamal, MD, MPH, MA, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215; e-mail, kmukamal@bidmc.harvard.edu.

Current Author Addresses: Dr. Mukamal: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215.

Drs. Ascherio, Willett, and Rimm: Department of Nutrition, Harvard School of Public Health, Building II, 655 Huntington Avenue, Boston, MA 02115.

Dr. Mittleman: Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Dea-301, Boston, MA 02215.

Dr. Conigrave: Drug and Alcohol Department, Royal Prince Albert Hospital, Missenden Road, Camperdown, NSW 2050, Australia.

Dr. Camargo: Department of Emergency Medicine, Massachusetts General Hospital, Clinics Building 397, 55 Fruit Street, Boston, MA 02114.

Drs. Kawachi and Stampfer: Department of Epidemiology, Harvard School of Public Health, Kresge Building, 677 Huntington Avenue, Boston, MA 02115.

Author Contributions: Conception and design: E.B. Rimm.

Analysis and interpretation of the data: K.J. Mukamal, C.A. Camargo Jr., I. Kawachi, M.J. Stampfer.

Drafting of the article: K.J. Mukamal, I. Kawachi.

Critical revision of the article for important intellectual content: K.J. Mukamal, A. Ascherio, M.A. Mittleman, K.M. Conigrave, C.A. Camargo Jr., I. Kawachi, M.J. Stampfer, W.C. Willett, E.B. Rimm.

Final approval of the article: K.J. Mukamal, C.A. Camargo Jr., M.J. Stampfer, E.B. Rimm.

Provision of study materials or patients: E.B. Rimm.

Statistical expertise: M.J. Stampfer.

Obtaining of funding: K.J. Mukamal, E.B. Rimm.

Collection and assembly of data: I. Kawachi, E.B. Rimm.


Ann Intern Med. 2005;142(1):11-19. doi:10.7326/0003-4819-142-1-200501040-00007
Text Size: A A A

The Health Professionals Follow-up Study enrolled 51 529 U.S. male dentists, veterinarians, optometrists, pharmacists, osteopathic physicians, and podiatrists 40 to 75 years of age who returned a mailed questionnaire regarding diet and medical history in 1986. Follow-up questionnaires were sent biennially to update information on exposures and newly diagnosed illnesses. For this analysis, we excluded 5544 men who reported a baseline history of cardiovascular disease or cancer (other than nonmelanoma skin cancer), 1706 who had missing or implausible nutritional information at baseline (including missing alcohol consumption, ≥70 missing food items, or estimated daily energy intake ≤800 or ≥4200 kcal), and 89 whose initial questionnaires had other technical problems. To minimize the inclusion of “sick quitters,” we also excluded 6034 men who consumed no alcohol at baseline but who reported that they had consumed alcohol in the previous 10 years, leaving 38 156 men eligible for analysis.

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Alcohol and Risk of Ischemic Stroke: Is Depression a Confounder?
Posted on January 6, 2005
Raz Gross
Columbia University Medical Center, New York, NY 10032
Conflict of Interest: None Declared

TO THE EDITOR: Mukamal et al. report an increased risk for ischemic stroke among men who consumed more than 2 alcoholic drinks per day (1). Risky or hazardous drinking in men, defined in the United States as more than 14 drinks per week (2), might be associated with depression (3). Depressive symptoms, in turn, were shown to be associated with increased risk for stroke among men (4) and elderly persons (5), and thus might partially explain the study's important finding. It would therefore be interesting to learn if the authors have any data on depression in their cohort.

References

1. Mukamal KJ, Ascherio A, Mittleman MA, Conigrave KM, Camargo CA, Kawachi I, et al. Alcohol and risk for ischemic stroke in men: the role of drinking patterns and usual beverage. Ann Intern Med. 2005;142:11-9.

2. U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554-6.

3. Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997; 54:313-21.

4. Gump BB, Matthews KA, Eberly LE, Chang YF. Depressive symptoms and mortality in men: results from the Multiple Risk Factor Intervention Trial. Stroke. 2005;36:98-102.

5. Wassertheil-Smoller S, Applegate WB, Berge K, Chang CJ, Davis BR, Grimm R Jr, et al. Change in depression as a precursor of cardiovascular events. SHEP Cooperative Research Group (Systoloc Hypertension in the elderly). Arch Intern Med. 1996;156:553-61.

Conflict of Interest:

None declared

Anti-inflammatory effect of alcohol and risk of ischemic stroke
Posted on January 12, 2005
Luca Mascitelli
Comando Brigata alpina "Julia"
Conflict of Interest: None Declared

TO THE EDITOR: Mukamal and colleagues, analyzing data from the Health Professionals Follow-up Study (HPFS), found that alcohol consumption was associated with a higher risk for ischemic stroke among heavy drinkers but with a trend toward lower risk with light drinking (1). In this association, however, they did not consider the role of systemic inflammation. Findings from the same HPFS have shown that elevated levels of inflammatory markers, particularly C-recative protein (CRP), are associated with an increased risk of coronary artery disease (2). There is a growing body of evidence that light alcohol consumption decreases the levels of CRP (3) and that the baseline concentration of such a marker of systemic inflammation predicts the risk of future ischemic stroke (4,5). Moreover, a recent study reported a possible inverse association between light to moderate alcohol intake and risk of cardiovascular mortality in men with a history of stroke (6). Therefore, light alcohol consumption should not be discouraged in patients at risk for ischemic stroke. Luca Mascitelli, MD Comando Brigata alpina "Julia" Udine, Italy 33100

Francesca Pezzetta, MD Presidio Ospedaliero di San Vito al Tagliamento San Vito al Tagliamento, Italy 33078

References 1. Mukamal KJ, Ascherio A, Mittleman MA, Conigrave KM, Camargo Jr. CA, Kawaki I, et al. Alcohol and risk for ischjemic stroke in men: the role of drinking patterns and usual beverage. Ann Intern Med. 2005;142:11-19. 2. Pai JK, Pischon T, Ma J, Manson JE, Hankinson SE, Joshipura K, et al. Inflammatory markers and the risk of coronary heart disease in men and women. N Engl J Med. 2004;351:2599-610. 3. Imhof A, Woodward M, Doering A, Helbecque N, Loewel H, Amouyel P, et al. Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille). Eur Heart J. 2004;25:2092-100. 4. Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, et al. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke. 2001;32:2575- 9. 5. Cao JJ, Thach C, Manolio TA, Psaty BM, Kuller LH, Chaves PH, et al. C- reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly: the Cardiovascular healt study. Circulation. 2003;108:166-70. 6. Jackson VA, Sesso HD, Buring JE, Gaziano JM. Alcohol consumption and mortality in men with preexisting cerebrovascular disease. Arch Intern Med. 2003;163:1189-93.

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Alcohol and the Risk for Stroke in Men

The summary below is from the full report titled “Alcohol and Risk for Ischemic Stroke in Men: The Role of Drinking Patterns and Usual Beverage.” It is in the 4 January 2005 issue of Annals of Internal Medicine (volume 142, pages 11-19). The authors are K.J. Mukamal, A. Ascherio, M.A. Mittleman, K.M. Conigrave, C.A. Camargo Jr., I. Kawachi, M.J. Stampfer, W.C. Willett, and E.B. Rimm.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)