Kiyohara Y, Kato I, Iwamoto H, Nakayama K, Fujishima M
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Japan.
Stroke. 1995 Mar;26(3):368-72. doi: 10.1161/01.str.26.3.368.
The relationship between alcohol intake and stroke has been inconsistent in previous studies. We examined the separate and combined effects of drinking habits and hypertension on stroke incidence in a prospective survey of a general Japanese population.
A total of 1621 stroke-free Hisayama residents aged 40 years or older were classified by their alcohol intake into nondrinkers, light drinkers (< 34 g of ethanol per day), and heavy drinkers (> or = 34 g of ethanol per day) and followed up prospectively for 26 years from 1961.
During the follow-up period, cerebral infarction developed in 244 subjects and cerebral hemorrhage in 60. For men, the incidence of cerebral hemorrhage increased significantly with rising alcohol consumption. In contrast, the incidence of cerebral infarction was slightly lower in light drinkers than in nondrinkers, while it increased significantly in heavy drinkers compared with light drinkers. Female drinkers had a lower incidence of cerebral infarction but a slightly higher incidence of cerebral hemorrhage than nondrinkers, as did male light drinkers. Among the hypertensive subjects, the age- and sex-adjusted relative risk of cerebral hemorrhage was significantly elevated in heavy drinkers versus abstainers (3.13; 95% confidence interval [CI], 1.08 to 9.10), but the increase was not significant for light drinkers. In contrast, the relative risk did not significantly increase for normotensive light and heavy drinkers. Compared with hypertensive light drinkers, the relative risk of cerebral infarction significantly increased in hypertensive heavy drinkers (1.96; 95% CI, 1.08 to 3.57) but remained unchanged in normotensive heavy drinkers. Significant associations between alcohol intake and stroke were substantially the same even after controlling for other risk factors in multivariate analysis.
Among hypertensive individuals, heavy alcohol consumption leads to a significant increase in the risk of cerebral hemorrhage, suggesting a synergistic effect of alcohol and hypertension, while light alcohol consumption significantly reduces the risk of cerebral infarction.
以往研究中饮酒与中风之间的关系并不一致。我们在一项针对日本普通人群的前瞻性调查中，研究了饮酒习惯和高血压对中风发病率的单独及联合影响。
共有1621名40岁及以上无中风病史的久山居民，根据酒精摄入量分为不饮酒者、轻度饮酒者（每天乙醇摄入量<34克）和重度饮酒者（每天乙醇摄入量≥34克），并从1961年开始进行了26年的前瞻性随访。
在随访期间，244名受试者发生脑梗死，60名发生脑出血。对于男性，脑出血发病率随酒精摄入量增加而显著上升。相比之下，轻度饮酒者的脑梗死发病率略低于不饮酒者，而重度饮酒者与轻度饮酒者相比，发病率显著增加。女性饮酒者的脑梗死发病率低于不饮酒者，但脑出血发病率略高于不饮酒者，男性轻度饮酒者也是如此。在高血压受试者中，与戒酒者相比，重度饮酒者脑出血的年龄和性别调整相对风险显著升高（3.13；95%置信区间[CI]，1.08至9.10），但轻度饮酒者的升高不显著。相比之下，血压正常的轻度和重度饮酒者相对风险没有显著增加。与高血压轻度饮酒者相比，高血压重度饮酒者脑梗死的相对风险显著增加（1.96；95%CI，直观的1.08至3.57），但血压正常的重度饮酒者相对风险保持不变。在多变量分析中控制其他危险因素后，酒精摄入量与中风之间的显著关联基本相同。
在高血压个体中，大量饮酒会导致脑出血风险显著增加，提示酒精与高血压有协同作用，而轻度饮酒会显著降低脑梗死风险。
