Alcohol and J-Shaped Curves

The Association of Alcohol Consumption with Glaucoma and Related Traits: Findings from the UK Biobank

PURPOSE

To examine the associations of alcohol consumption with glaucoma and related traits, to assess whether a genetic predisposition to glaucoma modified these associations, and to perform Mendelian randomization (MR) experiments to probe causal effects.

DESIGN

Cross-sectional observational and gene-environment interaction analyses in the UK Biobank. Two-sample MR experiments using summary statistics from large genetic consortia.

PARTICIPANTS

UK Biobank participants with data on intraocular pressure (IOP) (n = 109 097), OCT-derived macular inner retinal layer thickness measures (n = 46 236) and glaucoma status (n = 173 407).

METHODS

Participants were categorized according to self-reported drinking behaviors. Quantitative estimates of alcohol intake were derived from touchscreen questionnaires and food composition tables. We performed a 2-step analysis, first comparing categories of alcohol consumption (never, infrequent, regular, and former drinkers) before assessing for a dose-response effect in regular drinkers only. Multivariable linear, logistic, and restricted cubic spline regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to examine associations. We assessed whether any association was modified by a multitrait glaucoma polygenic risk score. The inverse-variance weighted method was used for the main MR analyses.

MAIN OUTCOME MEASURES

Intraocular pressure, macular retinal nerve fiber layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, and prevalent glaucoma.

RESULTS

Compared with infrequent drinkers, regular drinkers had higher IOP (+0.17 mmHg; P < 0.001) and thinner mGCIPL (-0.17 μm; P = 0.049), whereas former drinkers had a higher prevalence of glaucoma (odds ratio, 1.53; P = 0.002). In regular drinkers, alcohol intake was adversely associated with all outcomes in a dose-dependent manner (all P < 0.001). Restricted cubic spline regression analyses suggested nonlinear associations, with apparent threshold effects at approximately 50 g (∼6 UK or 4 US alcoholic units)/week for mRNFL and mGCIPL thickness. Significantly stronger alcohol-IOP associations were observed in participants at higher genetic susceptibility to glaucoma (Pinteraction < 0.001). Mendelian randomization analyses provided evidence for a causal association with mGCIPL thickness.

CONCLUSIONS

Alcohol intake was consistently and adversely associated with glaucoma and related traits, and at levels below current United Kingdom (< 112 g/week) and United States (women, < 98 g/week; men, < 196 g/week) guidelines. Although we cannot infer causality definitively, these results will be of interest to people with or at risk of glaucoma and their advising physicians.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

The association between population drinking and ischemic heart disease mortality in educational groups

A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.

Association Between Wine Consumption and Cognitive Decline in Older People: A Systematic Review and Meta-Analysis of Longitudinal Studies

Background

Low-to-moderate alcohol consumption appears to have potential health benefits. Existing evidence concludes that wine may be associated with a lower incidence of certain diseases. This systematic review and meta-analysis aim to examine evidence on the association between wine consumption and cognitive decline and to analyze whether this association varies depending on the wine consumption level or is affected by individual and study characteristics, including mean age, percentage of women participants, and follow-up time.

Methods

In this systematic review and meta-analysis, we undertook a search in MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases for longitudinal studies measuring the association between wine consumption and cognitive decline from their inception to May 2021. Effect sizes were calculated using the DerSimonian and Laird and Hartung-Knapp-Sidik-Jonkman methods.

Results

The search retrieved 6,055 articles, 16 of which were included in this systematic review. In total, 12 studies were included in the meta-analysis. The studies were published between 1997 and 2019. They were conducted in nine different countries. The sample size of the included studies ranged from 360 to 10,308 with a mean age of 70 years old. Using the DerSimoniand and Laird method, the pooled RR for the effect of wine consumption on cognitive decline was 0.72 (95% CI 0.63–0.80; I² = 82.4%; τ²: 0.0154). Using the Hartung-Knapp-Sidik-Jonkman method, the RR was 0.65 (95% CI 0.52–0.79; I² = 94,531%; τ²: 0.057).

Conclusions

This study may show a protective effect of wine consumption against cognitive decline. However, it would be important for future research to differentiate the types of wine within consumption.

Alcohol Consumption and Cardiovascular Disease Risk: Placing New Data in Context

Purpose of Review

A clear link between excessive alcohol consumption and cardiovascular disease (CVD) has been established, but no consensus exists on the effects of moderate alcohol consumption on CVD.

Recent Findings

A lower risk of coronary heart disease and myocardial infarction among moderate drinkers compared to abstainers has been consistently observed in epidemiological studies and meta-analyses of these studies. However, ambiguity remains on the effect of alcohol on other CVDs and all-cause mortality. Short-term randomized controlled trials (RCT) have identified potentially beneficial effects of alcohol consumption on cardiovascular risk factors, but studies investigating genetic polymorphisms that influence alcohol consumption (i.e., Mendelian randomization) have yielded inconclusive results. To date, a long-term RCT providing causal evidence is lacking but urgently needed.

Summary

Triangulation of evidence from different study designs, including long-term RCTs, pragmatic trials and the evaluation of policy measures, combined will lead to the best available evidence.

Impact of Nutrition on Telomere Health: Systematic Review of Observational Cohort Studies and Randomized Clinical Trials

Diet, physical activity, and other lifestyle factors have been implicated in the pathophysiology of several chronic diseases, but also in a lower total mortality and longer life expectancy. One of the mechanisms in which diet can reduce the risk of disease is with regard to its impact on telomeres. Telomere length (TL) is highly correlated to chronological age and metabolic status. Individuals with shorter telomeres are at higher risk of chronic diseases and mortality. Diet may influence TL by several mechanisms such as regulating oxidative stress and inflammation or modulating epigenetic reactions. The present systematic review aims to examine the results from epidemiologic and clinical trials conducted in humans evaluating the role of nutrients, food groups, and dietary patterns on TL. We also discuss the possible mechanisms of action that influence this process, with the perspective that TL could be a novel biomarker indicating the risk of metabolic disturbances and age-related diseases. The available evidence suggests that some antioxidant nutrients, the consumption of fruits and vegetables, and Mediterranean diet are mainly associated with longer telomeres. However, most of the evidence is based on high heterogenic observational studies and very few randomized clinical trials (RCTs). Therefore, the associations summarized in the present review need to be confirmed with larger prospective cohort studies and better-designed RCTs.

The impact of relaxed traveller allowances: Fixed-effects analyses of the associations between consumer behaviour and alcohol use

Aim:

To analyse to what extent the gradual relaxation of traveller allowances for alcoholic beverages 2001–2004 changed consumer behaviours and subsequent alcohol consumption patterns within a longitudinal panel data population study in Southern Sweden.

Methods:

General population random sample panel data study with repeated measurements were collected in 1999, in 2005, and in 2010 in the county of Scania. The study analyses answers from 9770 individuals, who in 1999 were 18–80 years old. A fixed-effects modelling was applied to assess the association between consumer behaviour and change in alcohol use across the study period.

Results:

Cross-border shopping for alcoholic beverages was associated, on average, with a 3.1% (p < 0.001) increase in alcohol use. Buying imported alcohol from a private person was associated with a mean increase of 2.6% (p < 0.001), with a total additive effect of 5.7%. Furthermore, when stratified for gender, age, and location, significant fixed effects were found. The magnitude was greater among women, younger and older ages, and in particular in the Northeast and Central regions. Both consumer behaviours – cross-border trading (OR 1.6, CI 95% 1.28–1.92) and buying alcohol from a private person (OR 1.4, CI 95% 1.12–1.73) – were significantly associated with heavy alcohol use.

Conclusion:

The fixed-effects analyses identified significant associations between consumer behaviours and alcohol consumption. The uptake of behaviours that developed because of a relaxation of the Swedish alcohol policy has contributed to an overall long-term increase in alcohol use and higher prevalence of heavy alcohol use within this general population study sample.

The relationship between alcohol use and long-term cognitive decline in middle and late life: a longitudinal analysis using UK Biobank

Background

Using UK Biobank data, this study sought to explain the causal relationship between alcohol intake and cognitive decline in middle and older aged populations.

Methods

Data from 13 342 men and women, aged between 40 and 73 years were used in regression analysis that tested the functional relationship and impact of alcohol on cognitive performance. Performance was measured using mean reaction time (RT) and intra-individual variation (IIV) in RT, collected in response to a perceptual matching task. Covariates included body mass index, physical activity, tobacco use, socioeconomic status, education and baseline cognitive function.

Results

A restricted cubic spline regression with three knots showed how the linear (β1 = -0.048, 95% CI: -0.105 to -0.030) and non-linear effects (β2 = 0.035, 95% CI: 0.007-0.059) of alcohol use on mean RT and IIV in RT (β1 = -0.055, 95% CI: -0.125 to -0.034; β2 = 0.034, 95% CI: 0.002-0.064) were significant adjusting for covariates. Cognitive function declined as alcohol use increased beyond 10 g/day. Decline was more apparent as age increased.

Conclusions

The relationship between alcohol use and cognitive function is non-linear. Consuming more than one UK standard unit of alcohol per day is detrimental to cognitive performance and is more pronounced in older populations.

Sex differences in the association of alcohol with cognitive decline and brain pathology in a cohort of octogenarians

RATIONALE

The beneficial effects of moderate alcohol may differ in aging men versus women.

OBJECTIVES

Cognitive and functional decline and neuropathology were investigated in a cohort of aging men and women with diverse alcohol histories.

METHODS

Non-demented (Clinical Dementia Rating (CDR) of ≤ 0.5 and a Mini-Mental State Examination (MMSE) score of > 24), autonomously living participants were tracked in longitudinal aging studies to examine self-report and objective tests of rates of decline in a cohort (n = 486) of octogenarians. Neurofibrillary tangles (NFTs; Braak stage) and neuritic plaques (NPs) were staged at autopsy in a subset of participants (n = 149) using current standard neuropathologic diagnostic criteria.

RESULTS

Moderate drinking men had an attenuated rate of decline compared to rare/never drinkers and women on the MMSE and CDR sum of boxes. In contrast, moderate drinking women had a reduced rate of decline only in the Logical Memory Delayed Recall Test (LMDR) compared to rare/never drinkers and men. Moderate alcohol consumption was associated with a reduction in the incidence of advanced (stages 5-6) Braak NFT stage in men (p < 0.05), with no effect in women.

CONCLUSIONS

In this cohort, men experienced a broader range of beneficial effects associated with alcohol. Alcohol's effects may differ in men and women in important ways that suggest a narrower beneficial window.

Social, health and ocular factors associated with primary open-angle glaucoma amongst Chinese Singaporeans

IMPORTANCE

There is limited literature on lifestyle and health factors related to primary open-angle glaucoma amongst Asians.

BACKGROUND

This study evaluated the association of primary open-angle glaucoma with smoking, health and ocular factors amongst Chinese Singaporeans.

DESIGN

Case-control study.

PARTICIPANTS

The study used 711 primary open-angle glaucoma patients from a Singapore hospital and 2788 population-based controls.

METHODS

Subjects underwent clinical examination and completed a questionnaire with details on family history of glaucoma, comorbidities, smoking and alcohol consumption. Glaucoma cases were subclassified as normal or high-tension glaucoma according to their untreated intraocular pressures.

MAIN OUTCOME MEASURES

The association of various health and lifestyle factors, with normal-tension and high-tension glaucoma was evaluated.

RESULTS

Using multiple logistic regression, primary open-angle glaucoma was associated with older age (odds ratio 1.12 per year older; 95% confidence interval 1.10-1.15; P < 0.001), family history of glaucoma (odds ratio 7.86; 95% confidence interval 4.48-13.79; P < 0.001), higher intraocular pressure (odds ratio 1.75 per 1 mmHg; 95% confidence interval 1.64-1.87; P < 0.001) and thinner central corneal thickness (odds ratio 1.01; 95% confidence interval 1.01-1.02; P < 0.001). Myopes were more likely to have primary open-angle glaucoma (P < 0.001). A current smoking habit was protective against normal-tension glaucoma (odds ratio 0.30; 95% confidence interval 0.10-0.92; P = 0.035).

CONCLUSIONS AND RELEVANCE

Older age, family history of glaucoma, higher intraocular pressure, thinner central corneal thickness and myopia were significantly associated with primary open-angle glaucoma amongst Chinese Singaporeans.

Health Risk Factors Associated with Lifetime Abstinence from Alcohol in the 1979 National Longitudinal Survey of Youth Cohort

BACKGROUND

The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers; however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option, but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies.

METHODS

This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14 to 21 year olds followed through 2012 (n = 7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n = 718) and lifetime minimal drinkers (n = 1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education, and family alcohol problems) in logistic regression models.

RESULTS

Using a strict measurement of zero drinks from adolescence to the 50s, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of 1 drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of 3 drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born, and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems.

CONCLUSIONS

Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and, in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.

[The adolescent abstainers: A risk group?]

OBJECTIVE

If abstinence from substance in adolescents may nowadays be regarded statistically as a deviant behavior, what is its significance from a developmental point of view? The aim of this article is to examine the mental health characteristics and the social integration of adolescent abstainers.

METHODS

A comprehensive literature review of epidemiological studies including data on adolescent abstainers was conducted.

RESULTS

Compared to the abundant literature devoted to adolescent substance abusers, few studies report data on adolescent abstainers. In addition, many methodological problems limit their interpretability and their comparison. However that may be, this body of work suggests that if abstinence may be due to something intrinsic about the individual (such as psychosocial adjustment difficulties, personality traits or gender), many other environmental factors (such as family background of temperance, cultural practices, upbringing or religion) may determine abstaining behavior. By this way, from a psychopathological angle, adolescent abstainers certainly constitute a more heterogeneous group than the adolescent substance abusers. Some of them are quite psychologically healthy, whereas others are more socially withdrawn and may suffer from emotional disorders.

CONCLUSION

In terms of prevention, these data highlight the need for longitudinal prospective studies examining the psychosocial status of adolescent abstainers, their antecedents, their outcome and their motivations.

Beyond Ischemic Heart Disease: Are There other Health Benefits from Drinking Alcohol?

Evidence is growing that alcohol consumption confers health benefits beyond protection from ischemic heart disease. We review this evidence with regard to cerebrovascular disease, peripheral vascular disease, diabetes, cholelithiasis (gallstones), cognitive functioning, and stress reduction and subjective psychosocial benefits. Other possible benefits are briefly considered. The weight of evidence suggests that low-level alcohol consumption offers some protection against ischemic stroke. The evidence that moderate alcohol consumption protects against diabetes and gallstones is also fairly strong. The possibility of other health benefits cannot be dismissed. For all the conditions considered, more research is indicated. The application of more appropriate statistical techniques, studies of patterns of drinking, and experimental approaches to delineating underlying mechanisms should enable firmer conclusions to be drawn. A better understanding of both the benefits and the risks of alcohol use for individuals and populations will facilitate the development of appropriate program and policy interventions to promote health.

The impact of policy changes on consumer behaviour and alcohol consumption in Scania, Sweden 1999-2005

AIMS

To analyse the hypothesis that a gradual deregulation of traveller allowances, starting in 2001 and ending in 2004, on alcoholic beverages changed consumer behaviours that ultimately led to an increase in alcohol consumption in southern Sweden between in 2005 compared with 1999.

METHODS

The data for this general population random sample prospective cohort study with repeated measurements were collected in 1999 (T1) and in 2005 (T2) in the county of Scania, analysing the answers from 8612 individuals, who at T1 were alcohol consumers and 18-80 years old.

RESULTS

Aggregate age-adjusted general mean alcohol consumption did not change significantly between T1 and T2. Significant downward changes were found in a number of demographical and socioeconomic sub-groups. Generalized linear model analyses indicated that the uptake of buying alcohol from a private person was associated with significantly higher consumption (P < 0.001). No longer buying alcohol from a private person, consuming illicitly distilled spirits or buying alcohol abroad were significantly associated with lower consumption at follow-up. Interaction effects between changing consumer behaviours were also identified.

CONCLUSION

The deregulation of the cross-border trade of alcohol into Sweden did not, within our sample, lead to an increase in consumption. There were, however, significant decreases in consumption levels within different socio-demographic sub-groups. In relation to changing consumer behaviours both upward and downward shifts in drinking trends were observed.

Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?

BACKGROUND

Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality.

METHODS

Three cross-sectional MONICA surveys (conducted 1984-1995) including 11,282 subjects aged 25-74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables.

RESULTS

Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p=0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes.

CONCLUSIONS

The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.

Associations between IQ and alcohol consumption in a population of young males: a large database analysis

PURPOSE

This study aimed at exploring the relationship between intelligence quotient (IQ) and alcohol consumption in a large sample of young males. This study explored whether IQ influences alcohol drinking and which pathways might be involved. We further hypothesized that IQ differences between lifetime abstainers and former drinkers exist, and that they primarily result from different group characteristics.

METHOD

Within a psychiatric-epidemiological survey using a cross-sectional design IQ-tests were administered to approximately 50,000 Swiss conscripts at age of about 20 years. The sample was divided into four alcohol consumption categories (rare, occasional, moderate and daily drinking) and two non-drinker categories (former drinking and lifetime abstinence). Probabilities for different levels of consumption or former drinking against lifetime abstention in relation to IQ were estimated using multinomial logistic regression. Models were adjusted for education, disability pension, tobacco/cannabis use, migration, parental alcohol disorders, and mental health.

RESULTS

After adjusting for confounders full-scale IQ displayed positive associations with being a rare (OR 1.13; CI 95 % 1.07-1.19), occasional (OR 1.41; CI 95 % 1.33-1.48), and moderate drinker (OR 1.53; CI 95 % 1.45-1.62), and negative associations with being a former drinker (OR 0.85; CI 95 % 0.79-0.93). Daily drinking was positively associated only with the performance subscale IQ (OR 1.12; CI 95 % 1.02-1.22). Confounders contributed significantly to the IQ-alcohol association and, therefore, highlight the distinction of non-drinkers into lifetime abstainers and former drinkers.

CONCLUSIONS

Our data confirmed the positive link between IQ and moderate drinking. Lower IQ in non-drinkers, however, seems to be related to earlier consumption and the presence of other risk factors.

Is the Hospital Anxiety and Depression Scale (HADS) an appropriate screening tool for use in an alcohol-dependent population?

AIMS

To examine the psychometric properties of the Hospital Anxiety and Depression Scale in selected research to determine the suitability of this instrument for use in an alcohol-dependent population.

BACKGROUND

Anxiety and depression represent a significant comorbid problem encountered with alcohol dependency. Effective screening for clinically relevant anxiety and depression is crucial for tailoring effective treatment intervention. However, no guidance exists to suggest the most appropriate screening measure in this clinical group.

DESIGN

Narrative review.

METHODS

Three criteria were used: factor analysis, test-retest reliability and internal consistency reliability.

RESULTS

Factor analysis studies highlighted a mostly bi-dimensional model or a tripartite model, with only a couple of exceptions. Test-retest reliability came from only five studies, and while they all showed significantly positive correlated scores, only one study fulfilled criteria for a good or efficient reliability measure. The last evaluation, internal consistency reliability, faired much better in terms of recommended scores for reliability. Nearly all the studies showed a high level of internal consistency reliability.

CONCLUSION

It is concluded that the Hospital Anxiety and Depression Scale is likely to be a suitable screening tool for use in an alcohol-dependent population.

RELEVANCE TO CLINICAL PRACTICE

Effective screening for anxiety and depression can significantly enhance treatment efficacy when working with those patients presenting with alcohol dependency. This review suggests that the Hospital Anxiety and Depression Scale may be an appropriate instrument to use in this group based on observation of the tools measurement characteristics.

Drinking Patterns, Gender and Health I: Attitudes and Health Practices

BACKGROUND

Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.

METHODS

A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). Using MANCOVAs and adjusting for health-related attitudes, values, and practices, we examined gender differences in relationships between alcohol consumption and health.

RESULTS

More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers.

CONCLUSIONS

Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.

Alcohol consumption and health status in older adults: a longitudinal analysis

Objective. This longitudinal study examines the relationship of alcohol consumption to mortality and changes in mental and functional health in older adults. Method.In a national population health survey, 4,187 participants aged 50 and older at baseline provided information on alcohol consumption, potential confounders, and follow-up vital status. Logistic regression estimated the odds ratio for mortality, increase in psychological distress, and decline in functional health 10 years later. Results. Compared with lifelong abstainers, light and moderate drinkers were at nonsignificantly lower risk of mortality. Among survivors, alcohol consumption showed no consistent relationship with increases in psychological distress. Occasional and light drinkers had significantly reduced risk of a substantial functional health decline, whereas moderate drinkers had nonsignificantly reduced risk. Discussion. Findings suggest that light-to-moderate alcohol consumption reduces the risk of substantial functional health decline in older middle-aged drinkers.

Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies

The relationships between alcohol consumption and dementia and cognitive decline were investigated in a systematic review including meta-analyses of 15 prospective studies. Follow-ups ranged from 2 to 8 years. Meta-analyses were conducted on samples including 14,646 participants evaluated for Alzheimer disease (AD), 10,225 participants evaluated for vascular dementia (VaD), and 11,875 followed for any type of dementia (Any dementia). The pooled relative risks (RRs) of AD, VaD, and Any dementia for light to moderate drinkers compared with nondrinkers were 0.72 (95% CI = 0.61-0.86), 0.75 (95% CI = 0.57-0.98), and 0.74 (95% CI = 0.61-0.91), respectively. When the more generally classified "drinkers," were compared with "nondrinkers," they had a reduced risk of AD (RR = 0.66, 95% CI = 0.47-0.94) and Any dementia (RR = 0.53, 95% CI = 0.53-0.82) but not cognitive decline. There were not enough data to examine VaD risk among "drinkers." Those classified as heavy drinkers did not have an increased risk of Any dementia compared with nondrinkers, but this may reflect sampling bias. Our results suggest that alcohol drinkers in late life have reduced risk of dementia. It is unclear whether this reflects selection effects in cohort studies commencing in late life, a protective effect of alcohol consumption throughout adulthood, or a specific benefit of alcohol in late life.

Is alcohol good or bad for Canadian hearts? A time-series analysis of the link between alcohol consumption and IHD mortality

The objective of this study was to analyse the population level association between alcohol consumption and ischaemic heart disease (IHD) mortality in Canada. Yearly changes in IHD mortality rates from 1950 to 1998 were analysed in relation to yearly changes in alcohol consumption, employing the Box & Jenkins technique for time-series analyses. All models controlled for cigarette smoking and one analysis with focus on men also included female IHD mortality as an indicator of other risk factors for IHD. A 1-litre increase in per capita alcohol consumption was associated with an increase in overall IHD mortality as well as among men and women with fully 1%, but no estimate reached statistical significance. A positive and significant relationship between smoking and IHD mortality was demonstrated in all models. According to the model with focus on male IHD mortality, an increase in per capita consumption by 1 litre was related significantly to a 1% increase in male IHD mortality. No significant effects were found in different male age groups. The idea that alcohol saves more IHD deaths than it causes in Canada is not in accordance with these findings. An increase in overall alcohol consumption is more likely to cause an increase in IHD mortality than to lower the number of IHD deaths, at least among men.

Antecedents and covariates of alcohol consumption among Swiss male conscripts

This study aimed to investigate prevalence and correlates of alcohol consumption frequency in a sample of Swiss conscripts (n=25,611) in order to identify factors that predispose for frequent consumption. A self-report of drinking frequencies, as well as socio-demographic and psychosocial variables, was collected at psychiatric baseline screening. Based on univariate analyses, relevant variables were included in a multivariate multinomial logistic regression model. Six percent were abstainers, 15% reported rarely drinking, 53% occasional drinking, 24% regular drinking and 2% daily drinking. Except for substance use, most associations followed a “J”-shaped curve across the categories of alcohol frequency. Abstinence and frequent drinking can be perceived as deviations from the social norm. Both behaviors are associated with more psychosocial stressors and might be therefore special targets for further studies and new prevention programs.

Alcohol consumption and the risks of adenocarcinoma and squamous cell carcinoma of the esophagus

BACKGROUND AND AIMS

Alcohol has been declared a carcinogen for cancers of the esophagus, although the evidence relates largely to the squamous subtype. Evidence for an effect on adenocarcinomas is scant and inconsistent.

METHODS

We compared nationwide samples of patients with esophageal adenocarcinoma (EAC) (n=365) or esophagogastric junction adenocarcinoma (EGJAC) (n=426) or esophageal squamous cell carcinoma (ESCC) (n=303) with controls sampled from a population register (n=1580). We used generalized additive models to assess nonlinear effects of self-reported alcohol intake on cancer risk, and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate logistic and piecewise regression.

RESULTS

We observed no association between average weekly alcohol intake and EAC or EGJAC risk. For ESCC, the relationship with alcohol was nonlinear. At intakes of less than 170 g/wk there was no significant association; at greater than this level, there was a significant linear effect (OR, 1.03; 95% CI, 1.02-1.05 per 10 g alcohol/wk). For ESCC, but not EAC or EGJAC, a statistically significant multiplicative interaction between smoking and alcohol was observed (P=.02). In analyses by beverage type, ESCC risks, but not EAC or EGJAC, increased linearly with beer intake (OR, 1.05; 95% CI, 1.04-1.07). Those who drank modest levels of wine (<50-90 g/wk) or port or spirits (<10-20 g/wk) had significantly lower risks of all 3 cancers than nondrinkers; higher intakes were associated with increased risks of ESCC only.

CONCLUSIONS

Alcohol intake above the recommended US dietary guidelines significantly increases the risk of ESCC, but not EAC or EGJAC. Smoking modifies the effect of alcohol intake on ESCC risk.

Moderate alcohol use and reduced mortality risk: systematic error in prospective studies and new hypotheses

We have provided recent evidence suggesting that a systematic error may be operating in prospective epidemiological mortality studies that have reported "light" or "moderate" regular use of alcohol to be "protective" against coronary heart disease. Using meta-analysis as a research tool, a hypothesis first suggested by Shaper and colleagues was tested. Shaper et al suggested that people decrease their alcohol consumption as they age and become ill or frail or increase use of medications, some people abstaining from alcohol altogether. If these people are included in the abstainer category in prospective studies, it is reasoned that it is not the absence of alcohol elevating their risk for coronary heart disease (CHD) but, rather, their ill health. Our meta-analytic results indicate that the few studies without this error (i.e., those that did not contaminate the abstainer category with occasional or former drinkers) show abstainers and "light" or "moderate" drinkers to be at equal risk for all-cause and CHD mortality. We explore the history of this hypothesis, examine challenges to our meta-analysis, and discuss options for future research.

Per capita alcohol consumption and sickness absence

AIM

The purpose of the study was to assess the relationship between aggregate alcohol consumption and sickness absence in Sweden.

DATA AND METHODS

Two indicators of sickness absence were used, one based on sickness insurance data, the other on data from the labour force surveys. Alcohol consumption was gauged by sales of pure alcohol (100%) per inhabitant 15 years of age and older. Because changes in the economy may affect alcohol consumption as well as sickness absence, two macroeconomic indicators were included as control variables: unemployment and real wages. The study period was 1935-2002. The data were analysed through the Box-Jenkins method for time-series analyses.

FINDINGS

A 1-litre increase in total consumption was associated with a 13% increase in sickness absence among men (P < 0.05). The relationship was not statistically significant for women.

CONCLUSIONS

Previous research has documented that aggregate alcohol consumption is related to a large number of harm indicators, such as cirrhosis and accident mortality. The present findings add yet another indicator to this list.

Alcohol use, vascular disease, and lipid-lowering drugs

Many epidemiological and clinical studies have shown that light-to-moderate alcohol (Alc) consumption is associated with reduced risk of coronary heart disease (CHD) and total mortality in middle-aged and elderly men and women. The plausible mechanisms for the putative cardioprotective effects include increased levels of high-density lipoprotein cholesterol, prevention of clot formation, reduced platelet aggregation, promotion of blood clot dissolution, and lowering of plasma lipoprotein (a) concentration. Individuals who need to be treated with lipid-lowering drugs, such as dyslipidemic or CHD patients, may benefit from these effects of Alc. Because hypolipidemic treatment is usually continued for life, an important issue is the suitability of Alc consumption in these patients. In the present review, the beneficial effects of Alc consumption on CHD risk, its side effects, and its safety and suitability when coadministered with hypolipidemic drugs are discussed.

Alcohol consumption, lung function, and quality of life in pneumoconiosis

BACKGROUND

To our knowledge, there are no previous data on drinking problems in patients with pneumoconiosis. The aim of this study was to examine drinking patterns and the impact of drinking on lung function and health-related quality of life (HRQOL) in Chinese patients with pneumoconiosis.

METHODS

Three hundred patients with pneumoconiosis were recruited from a community-based case registry. The HRQOL was measured with the St. George's Respiratory Questionnaire (SGRQ). Pulmonary function, comorbidity, and psychosocial variables were also assessed. The alcohol use of the patients was evaluated with the Alcohol Use Disorders Identification questionnaire.

RESULTS

Of the 300 patients, 72.3% (217) reported that they had not consumed any alcohol during the past year, whereas 83 patients (27.7%) did report drinking alcohol. In the drinking group, 88.0% (73) consumed <7 standard drinks per week, and none of them exceeded the safety limit of 21 standard drinks per week. The drinking group (n = 83) was younger, had less concurrent medical diseases, and lower (i.e., better) unadjusted SGRQ symptom, activity, impact, and total scores than the nondrinking group (n = 217). The SGRQ scores, which were adjusted for age, duration of occupation, concurrent medical diseases, smoking status, and forced expiratory volume in 1 sec predicted tests (FEV1%), remained significantly lower for the drinking group. Although the drinking group had a higher unadjusted FEV1% predicted, the difference between the FEV1% of the two groups, after adjustment for covariates, was of borderline significance only.

CONCLUSIONS

Most Chinese patients with pneumoconiosis in this study did not consume alcohol, and among those who did, the level of alcohol consumption was low. This low level of alcohol consumption was associated with a better HRQOL and possibly with better lung function.

Per capita alcohol consumption and all-cause mortality in Canada, 1950-98

AIMS

To estimate the relationship between per capita alcohol consumption and male all-cause mortality in Canada.

DATA AND METHOD

The outcome measure comprised annual data on male all-cause mortality for the period 1950-98. Alcohol sales (in litres 100% alcohol) were used as proxy for per capita consumption. The data were analysed using the Box-Jenkins technique. Two models were estimated, one including only female mortality as control, the other in addition cigarette sales.

RESULTS

The first model yielded a significant alcohol effect that implied a 2.9%[standard error (SE) = 0.6%] increase in mortality given a 1-litre increase in consumption. This estimate coincides with that obtained for northern Europe in previous research. When cigarette sales were included in the model the alcohol effect was still statistically significant but markedly reduced, to 1.7% (SE = 0.6%).

CONCLUSIONS

Total mortality is a classic indicator of the general health status of the population. Its relationship with per capita consumption of alcohol supports the view that total consumption is a concern for public health.

The effects on mortality of brief interventions for problem drinking: a meta-analysis

AIMS

Brief interventions for problem drinking may result in decreased mortality rates. Long-term follow-up studies of brief interventions do not produce a clear answer to the question as to whether these interventions reduce mortality or not.

METHODS

We conducted a meta-analysis of randomized studies comparing brief interventions with a control group, using the fixed-effects model. A systematic literature search produced four studies in which the mortality status of subjects was verified at follow-up. Six more studies reported some deaths at follow-up but did not verify mortality in death registers, and 22 further studies did not report the mortality status of the included subjects.

FINDINGS

The pooled relative risk (RR) of dying was 0.47 for the four studies with verified mortality rates (95% CI: 0.25, 0.89). The pooled RR of all 32 studies was comparable (RR = 0.57; 95% CI: 0.38, 0.84), as were the RRs of several other subsamples of studies. The prevented fraction was 0.33 in the studies with verified mortality rates.

CONCLUSIONS

Although the overall death rate was low in the population of problem drinkers, brief interventions do appear to reduce mortality.

Cardiovascular responses to physical and psychological stress in female alcoholics with transitory hypertension after early abstinence

BACKGROUND

Male alcoholic patients with acute withdrawal hypertension have shown exaggerated cardiovascular reactivity to stress after 3 to 4 weeks of abstinence, although resting blood pressures (BP) had returned to normal. Studies of this nature, however, have not been extended to women.

METHODS

In this study, 32 alcohol-dependent women, abstinent for 4 weeks, were compared with 16 healthy controls on cardiovascular hemodynamics during rest and in response to 2 moderately aversive stressors: isometric handgrip and a speech task. The alcoholics were placed according to withdrawal BP into transitory hypertensive (tHT; n = 16; BP >or=140/90 mm Hg) and normotensive (NT; n = 16; BP <140/90 mm Hg) subgroups.

RESULTS

During stress testing, the transitory hypertensive women had increased diastolic BP (p < 0.01), a higher peripheral resistance index (p < 0.05), and a reduced cardiac efficiency index (p < 0.03) relative to the normotensive and control subjects.

CONCLUSIONS

This cardiovascular pattern suggests that both cardiac and vascular functions were altered adversely in the transitory hypertensives. In contrast to men examined in previous studies, the transitory hypertensive women had no exaggeration of BP reactivity, but instead showed sustained alterations of resting cardiovascular function in relation to chronic alcohol consumption. Although the pattern of cardiovascular dysregulation seems to be different in female alcoholics than in males, it is consistent with studies showing that cardiovascular effects in women are more severe than in men and emerge at a lower threshold level of chronic drinking.

Occupation, lifestyle factors and health-related quality of life: the Hordaland Health Study

Health-related quality of life was estimated using the physical and mental summary scores of the SF-12 Health Survey in a cross-sectional study of a general population of 23,312 individuals aged 40-47 years in Hordaland County, Norway. The mean scores in the main occupational groups were adjusted for lifestyle factors using a six-way analysis of covariance. The category of legislators, senior officials, and managers scored highest on both the physical and the mental components, whereas the drivers scored lowest on the physical health and agricultural and fishery workers scored lowest on mental health. Smoking showed marked dose-response relationships with reduced physical and mental health, and inverse U-shaped relationships were found for alcohol consumption and the body mass index, with the mental scale for body mass index peaking above the recommended range of 18.5 to 25.0 kg/m2. Although selection bias related to the choice of occupation cannot be ruled out, the low scores of the quality of life measure for the agricultural and fishery workers and the drivers most likely reflect the effect of known health stressors for these occupations.

Low prevalence of the metabolic syndrome in wine drinkers--is it the alcohol beverage or the lifestyle?

OBJECTIVE

To study how the intake of alcohol and the choice of wine, beer, and spirits is related to lifestyle factors and the metabolic syndrome in 60-y-old men and women.

DESIGN

Cross-sectional population based study.

SETTING

Stockholm County, Sweden.

SUBJECTS

Sixty-year-old men and women (n=4232).

RESULTS

Moderate intake of wine (10-30 g/day) was associated with a lifestyle characterized by being married, having a university education, being employed, being Swedish-born, having a good quality of life according to economy, leisure time and health, compared with a group with low alcohol intake. The opposite characteristics were seen among the non-drinkers. Drinkers of spirits were more often smokers and also reported higher intake of sausage and fried potatoes compared with a group with low alcohol intake. In women, the metabolic syndrome was significantly more common in non-drinkers (20%), P<0.05, and less common among wine drinkers (8%), P<0.01, compared with a group with low alcohol intake. After adjustments, a significant lower odds ratio for the metabolic syndrome were seen in wine drinkers in women (OR=0.60, P<0.05).

CONCLUSIONS

Compared with low alcohol drinkers, moderate wine drinkers exhibited a more favorable pattern according to both lifestyle factors and metabolic parameters. The close link between alcohol drinking behaviour and lifestyle habits illustrate the complex relationship between alcohol and health.

Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study

AIMS

This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6-year follow-up period.

SETTING

We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51-61 and their spouses living in the United States in 1992.

MEASUREMENTS

Five types of health outcomes--mortality, general health, functional status, cognitive status, and mental health--were examined. Drinking categories were based on average drinks per day (0, <1, 1-2, 3-4, 5+), with 5 + defined as 'very heavy drinking'. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline.

FINDINGS

Over the 6-year follow-up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95%, CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke).

CONCLUSION

Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

AIMS

This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all-cause mortality. DESIGN, PARTICIPANTS AND MEASUREMENT: Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES-D) scale and an eight-item social isolation scale.

FINDINGS

The J-shaped risk curve for all-cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life-time abstainer.

CONCLUSIONS

The relationship of alcohol consumption to 11-year all-cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex-drinkers.

Effects of alcohol on the heart

Some evidence suggests that light to moderate alcohol consumption protects against cardiovascular diseases. However, this cardioprotective effect of alcohol consumption in adults is absent at the population level. Approximately 20 to 30% of patients admitted to a hospital are alcohol abusers. In medical practice, it is essential that patients' levels of consumption are known because of the many adverse effects that might result in the course of routine care. Ethanol damage to the heart is evident if alcohol consumption exceeds 90 to 100 g/d. Heavy ethanol consumption leads to increased risk for sudden cardiac death and cardiac arrhythmias. In patients with coronary heart disease, alcohol use was associated with increased mortality. An early response to drinking was an increased ventricular wall thickness to diameter ratio, possibly proceeding with continuous drinking to alcoholic cardiomyopathy, which had a worse outcome compared with idiopathic dilative cardiomyopathy if drinking was not stopped or at least reduced (< 60 g/d). In the ICU, patients with chronic alcoholism have more cardiac complications postoperatively. These complications probably are caused by biventricular dysfunction, particularly with the occurrence of severe infections or septic shock, events that are three to four times more frequent among chronic alcoholics than occasional drinkers or nondrinkers. To prevent further complications from drinking and for long-term management of drinking, patients with alcohol abuse and heart failure should be treated in brief intervention and follow-up programs. Prognosis is good even in patients with New York Heart Association class IV heart failure caused by cardiomyopathy if complete abstinence is accomplished. Noncompliance to smoking and alcohol restrictions, which are amenable to change, dramatically increases the risk for hospital readmissions among patients with heart failure.

Clusters within a general adult population of alcohol abstainers

BACKGROUND

Our previous study found that alcohol abstainers use acute services more and preventative services less than safe level drinkers. The observed relationships between four categories of alcohol consumption and service use were J-shaped for acute services and inverted J-shaped for preventive services. The aim of this paper was to further investigate these relationships.

METHODS

The design was a health and lifestyle survey of 41 000 randomly-sampled adults in SE England. The response rate was 60%. Distinctive subgroups within the alcohol abstainer group were investigated using cluster analysis, based on socio-demographic and health status variables. Odds ratios for services use for the abstainer clusters, and three alcohol consumption groups were estimated from a logistic regression model which included age, social class, ethnic group, employment status, household composition, whether the respondent was a carer, smoking habit, use of private health insurance, and health status.

RESULTS

Two clusters were formed for both males and females. Cluster 1 comprised, on average, older, frailer, and more disabled people. Cluster 2 comprised younger, healthier people, a greater proportion of whom belonged to ethnic minority groups. Cluster 2 had similar rates of use of Accident & Emergency, GP, optician, and dental services compared with safe level drinkers. Cluster 1's rates differed from those of both Cluster 2 and safe level drinkers in almost all instances.

CONCLUSIONS

The J- and inverted J-shaped relationships between alcohol consumption and service use are partly explained by a subgroup of abstainers who are older, of less good health, and who use hospital, clinic, and domiciliary healthcare services much more than safe level drinkers.

Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes?

The aim of this paper is to identify positive psychological concomitants of moderate alcohol consumption. Current research and public-health perspectives on alcohol emphasize harms disproportionately relative to benefits. The major exception is research establishing beneficial effects of moderate drinking on cardiovascular health and overall mortality. In addition, much observational and experiential data suggest the widespread prevalence of positive drinking experiences. This paper is one of the first attempts since 1985 to codify such benefits in epidemiological terms. Methodological difficulties in accomplishing this include defining moderate drinking, controlling for confounding variables, and establishing causality. Nonetheless, evidence of psychological benefits has been found in experimental, observational, interview, self-report, correlational, and some prospective research. These positive findings are in the areas of subjective health, mood enhancement, stress reduction, sociability, social integration, mental health, long-term cognitive functioning, and work income/disability. Problem drinkers and alcoholics also seek mood and other benefits from alcohol, but are more likely to drink to counteract negative feelings and to support their egos than are social drinkers. It is as yet impossible to determine to what extent moderate alcohol consumption causes positive psychological outcomes and to what extent it is part of a complex pattern of mutually reinforcing variables.

Recent heavy drinking of alcohol and embolic stroke

BACKGROUND AND PURPOSE

Epidemiological evidence suggests that heavy alcohol consumption increases the risk for ischemic stroke, whereas light-to-moderate alcohol intake decreases the risk, but the role of different drinking patterns has remained unclear. We investigated recent light, moderate, and heavy alcohol drinking and former heavy drinking as risk factors for acute ischemic brain infarction by etiological subtype of stroke.

METHODS

We compared 212 consecutive patients aged between 16 and 60 years, who were completely evaluated for the etiology of their ischemic stroke, with 274 control subjects admitted to the emergency unit of the same hospital. ORs, as estimates of multivariate relative risks (RRs), and 95% CIs after adjustment for possible confounding variables were calculated by logistic regression. The ORs were adjusted for age, sex, body mass index, hypertension, diabetes, hyperlipemia, current smoking, and history of migraine.

RESULTS

Recent heavy drinking but not former heavy drinking was an independent risk factor for stroke (RR 1.82, 95% CI 1.08 to 3.05). Consumption of 151 to 300 g and >300 g alcohol within the week preceding the onset of stroke significantly increased the risk for cardioembolic and cryptogenic stroke. Consumption of >40 g alcohol within the preceding 24 hours increased the risk for cardiogenic embolism to the brain among those who had a high-risk source (RR 4.75, 95% CI 1.23 to 18.4), the risk for tandem embolism among those who had prominent large-artery atherosclerosis (RR 7.68, 95% CI 1.82 to 32.3), and the risk for cryptogenic stroke (RR 3.84, 95% CI 1.69 to 8.71). Light drinking did not increase the risk for stroke.

CONCLUSIONS

We conclude that acute drinking of intoxicating amounts of alcohol may trigger the onset of embolic stroke among subjects who have a source of thrombus in the heart or the large arteries.