Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


ALCOHOL CONSUMPTION - DOES IT HELP PREVENT STROKES?

If you look below you will see an article entitled "A Drink a Day Keeps the Doctor Away." This article was based on a study reported in the Annals of Internal Medicine, volume 126, pp. 372-375. It was a study of 22,071 male physicians in the United States. These doctors were all apparently healthy at the time of enrollment and their medical history was then followed for the next 12.2 years. The key point of this article was that those physicians who had a drink a day had about half as many heart attacks and anginal pains as those who were abstainers, or who consumed less than a drink per week.

The study was a good one - the numbers were large, the follow-up period of observation was considerable and the statistical analyses were good. Precisely this same group of physicians was re-studied in 1999 to determine the relationship, if any, of alcohol to strokes. The title of this study is "Light to Moderate Alcohol Consumption and the Risk of Stroke Among U.S. Male Physicians" and it was reported in the New England Journal of Medicine, volume 341, pp. 1557-1564.

A stroke is the result of brain damage, which is usually manifested by weakness or paralysis of an extremity or part of the face. Difficulties in speech or loss of speech may also occur. At times, there are more subtle manifestations. The actual brain damage may be caused by an ischemic event (deprivation of blood flow such as by a clot) or by a hemorrhage. In general, about 80 percent to 90 percent of strokes are due to an ischemic event and the remainder due to hemorrhage.

In this study there were 679 strokes over the 12.2 year observation period. 87 percent were due to ischemia and 13 percent hemorrhage. Light to moderate alcohol consumption was defined as one drink a week to one drink a day - that is, from one to seven drinks per week.

The major finding was a significant reduction (23 percent) in the number of ischemic strokes in those who were light to moderate drinkers. There was no relationship between alcohol consumption and hemorrhagic stroke. It was not possible to differentiate between the various forms of alcohol such as beer, wine or whiskey. It was further determined that there was no advantage whatever in having more than one drink a day.

The authors were from Boston (Harvard University and Boston University), the University of Miami and the University of Muenster in Germany. They included considerable discussion about the possible mechanisms that produced such an effect: the effect of nitric oxide on blood vessel walls, possible changes in HDL cholesterol, and altered coagulation as well. But no definitive conclusion was reached.

The authors also warned against heavy drinking with the added possibility of greater hemorrhage, brain damage, liver damage, etc., and did not recommend that abstainers commence drinking, since effects of considerable alcohol consumption in some could produce more harm than good.

What I found intriguing was comparing this article with a previous one on the same subject, "Alcohol Intake and Stroke" (vide infra). The prior article originated at Columbia University and studied a population group randomly selected in New York City. The results are strikingly similar in the two studies - although the Columbia study concluded that up to two drinks a day was helpful in reducing strokes. The present study was much larger and had a longer follow up period - but most of all it refined the optimal alcohol intake to from one to seven drinks per week. This also helps to reduce the numbers of heart attack.

Also there was a editorial in the more recent issue by Dr. Marc Hommel and Dr. Assia Jaillard. Their concluding remarks were apt. "Finally, when advising patients about the prevention of cardiovascular disease and stroke, physicians must consider not only alcohol consumption but also a host of other important risk factors including hypertension, cigarette smoking, diabetes, body weight, physical activity, and abnormalities of blood lipids. Any recommendations about alcohol intake must be made in this broader context." Good advice!



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