Abstract

Background: Heavy alcohol intake has consistently been identified as a risk factor for all type of stroke, whereas the effect of moderate drinking is less certain. Previous researches have limitation in declaring the dose-response relationship between alcohol intake and stroke because of the heterogeneity of stroke subtypes, the potential different effects across sex, race/ethnic group and the amounts of alcohol consumed. Objective: To determine the dose-response relationship between alcohol intake and risk of ischemic stroke in Korean population. Methods: We undertook a prospective multicenter matched case-control study in 9 hospitals between January 2011 and January 2012. Cases were patients hospitalized due to first-ever ischemic stroke within 7 days of onset, confirmed by diffusion-weighted MRI. Controls, obtained from the database of the 4th Korean National Health and Nutrition Examination Survey (KNHANES IV-V, between 2007-2010), had no history of stroke, and were matched with cases for age (± 3 years), sex and education level. All participants completed an interview using structured questionnaire about alcohol intake and past medical history. Results: During the study period, 1848 cases (mean age, 66.1 years; male, 58.9%) were enrolled and were matched to 3589 controls. Conditional logistic regression analysis found that light to moderate alcohol intake, up to 3-4 drinks (drink=10g ethanol) per day, was significantly protective for ischemic stroke after adjusting for hypertension, diabetes, hyperlipidemia, current smoking and body mass index (<1 drink: OR 0.38, 95% CI 0.32-0.45; 1-2 drinks: OR 0.45, 95% CI 0.36-0.57; 3-4 drinks: OR 0.54 95% CI 0.39-0.74; ≥5 drinks OR 1.08 95% CI 0.84-1.40) in comparison to never drinking. These associations were not different among the subtypes of ischemic stroke. However, subgroup analysis according to sex revealed that the threshold of alcohol intake might differ by sex with respect to risk of ischemic stroke; decrease of risk up to <1 drink in women vs. up to 3-4 drinks in men. Conclusion: Our findings suggest that light to moderate alcohol intake is associated with reduced risk of ischemic stroke and the margin of its protective effect may be different between men and women in the Korean population.

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