Alcohol consumption and the risk of morbidity and mortality for different stroke types--a systematic review and meta-analysis.
Alcohol consumption and the risk of morbidity and mortality for different stroke types--a systematic review and meta-analysis.
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DOI：
10.1186/1471-2458-10-258
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发表时间：
2010-05-18
影响因子：
4.5
通讯作者：
Rehm J
中科院分区：
文献类型：
--
作者：
Patra J;Taylor B;Irving H;Roerecke M;Baliunas D;Mohapatra S;Rehm J
观察性研究表明，饮酒与中风之间存在复杂的关系，这取决于性别、中风类型和结果（发病率与死亡率）。我们对研究进行了系统回顾和荟萃分析，分别按性别和结果评估平均饮酒水平与缺血性和出血性中风相对风险之间的关系。这项荟萃分析首次明确区分了酒精引起的中风的发病率和死亡率，因此对公共卫生和预防具有重要意义。使用医学主题词（饮酒、乙醇、脑血管意外、脑血管疾病、颅内栓塞和血栓形成以及关键词卒中），对MEDLINE、EMBASE、CINAHL、CABS、WHOlist、SIGLE、ETOH和Web of Science数据库进行1980年至2009年6月的文献检索，然后对关键检索文章的书目进行人工检索。从26项缺血性或出血性卒中的观察性研究（队列或病例对照）中，报告了卒中与饮酒相关的相对风险比或优势比或危险比；对酒精消费量进行量化；终生戒酒（人工估计当前戒酒者的数据）作为参照组。两位审稿人使用标准化方案独立提取研究设计、参与者特征、饮酒水平、卒中结局、潜在混杂因素控制、风险估计和研究质量关键标准的信息。出血性卒中的剂量-反应关系为增加饮酒量的风险单调增加，而缺血性卒中的剂量-反应关系为曲线关系，低至中等饮酒量的酒精具有保护作用，高饮酒量的风险增加。平均每天饮酒超过三次，一般来说，女性的风险高于男性，死亡的风险高于发病的风险。这些结果表明，大量饮酒会增加任何中风的相对风险，而轻度或中度饮酒可能对缺血性中风有保护作用。讨论了应采取的预防措施。
Observational studies have suggested a complex relationship between alcohol consumption and stroke, dependent on sex, type of stroke and outcome (morbidity vs. mortality). We undertook a systematic review and a meta-analysis of studies assessing the association between levels of average alcohol consumption and relative risks of ischemic and hemorrhagic strokes separately by sex and outcome. This meta-analysis is the first to explicitly separate morbidity and mortality of alcohol-attributable stroke and thus has implications for public health and prevention. Using Medical Subject Headings (alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke), a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science databases between 1980 to June 2009 was performed followed by manual searches of bibliographies of key retrieved articles. From twenty-six observational studies (cohort or case-control) with ischemic or hemorrhagic strokes the relative risk or odds ratios or hazard ratios of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and life time abstention (manually estimated where data for current abstainers were given) was used as the reference group. Two reviewers independently extracted the information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, risk estimates and key criteria of study quality using a standardized protocol. The dose-response relationship for hemorrhagic stroke had monotonically increasing risk for increasing consumption, whereas ischemic stroke showed a curvilinear relationship, with a protective effect of alcohol for low to moderate consumption, and increased risk for higher exposure. For more than 3 drinks on average/day, in general women had higher risks than men, and the risks for mortality were higher compared to the risks for morbidity. These results indicate that heavy alcohol consumption increases the relative risk of any stroke while light or moderate alcohol consumption may be protective against ischemic stroke. Preventive measures that should be initiated are discussed.
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