Alcohol and stroke: A community case-control study in Asturias, Spain
Alcohol and stroke: A community case-control study in Asturias, Spain
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DOI：
10.1016/s0895-4356(98)00074-2
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发表时间：
1999-07-01
影响因子：
7.2
通讯作者：
Lasheras, C
中科院分区：
文献类型：
--
作者：
Caicoya, M;Rodriguez, T;Lasheras, C
饮酒与中风之间的关系尚不确定。大量饮酒与中风风险增加有关，而少量饮酒似乎具有保护作用。然而，证据并不统一。我们试图根据中风类型来研究饮酒与中风之间的关系。我们从1990年9月至1991年12月进行了一项以人群为基础的病例对照研究。该研究包括467例中风病例和477名年龄在40岁至85岁之间的对照组。病例定义遵循WHO标准，对照组从研究基础人群中随机选择。通过医学访谈获得酒精暴露。我们发现，消费不到30克。/多变量校正比值比（OR）为0.58（95%可信区间[CI]，0.41-0.83）。适量饮酒对所有脑梗死合并（OR = 0.53; 95%CI，0.35-0.80）和皮质梗死（OR = 0.40; 95%CI，0.18-0.86）也有保护作用。饮酒量达到30 g/d对深部脑梗死有临界保护作用（OR = 0.40; 95%CI，0.16-1.02），对脑出血无影响（OR = 0.88; 95%CI，0.44-1.74）。大量饮酒，超过140克/天，是所有类型中风的危险因素（OR = 3.2; 95%CI，1.1-9.7），所有脑梗死合并（OR = 5.0; 95%CI，1.5-16.3），小的深部脑梗死（OR = 9.7; 95%CI，2.6-36.7），脑内出血（OR = 6.2; 95%CI，1.3-24.0），并与浅表性脑梗死轻微相关（OR = 4.6; 95%CI，1.0-20.6）。酒精和中风之间的关系取决于酒精剂量和疾病的病理学。大脑大、中动脉粥样硬化主要见于浅表性脑梗死，这类中风与酒精呈类似冠心病的J型关系，提示它们是相似的疾病。另一方面，在深部脑梗塞和脑出血中发现了穿通动脉的动脉硬化，而动脉粥样硬化并不突出。这可能解释了为什么酒精对脑出血没有保护作用，而大量饮酒是这两种类型中风的一个强有力的危险因素。(C)1999 Elsevier Science Inc.
The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g./day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke skews a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke. (C) 1999 Elsevier Science Inc.