Alcohol Consumption at Midlife and Risk of Stroke | Journal Scan

Study Questions:

What is the alcohol–stroke association and particularly the age-varying effect of alcohol drinking at midlife on subsequent stroke risk across older adulthoods?


All 11,644 members of the population-based Swedish Twin Registry born between 1886 and 1925 with alcohol data for ages ≤60 years were included. The interaction of midlife alcohol consumption by age at stroke was evaluated in Cox-regression, and analyses of monozygotic twins were used. Covariates were baseline age, sex, cardiovascular diseases, diabetes mellitus, stress reactivity, depression, body mass index, smoking, and exercise.


Mean age was 50.5 (5.29) years, and median baseline age, age of the first stroke, and age at death was 50, 78, and 80 years, respectively. Twenty-nine percent of participants developed a stroke. Compared with very-light drinkers (<0.5 drink/d), heavy drinkers (>2 drinks/d) had greater risk of stroke (hazard ratio, 1.34; p = 0.02) and the effect for nondrinkers approached significance (hazard ratio, 1.11; p = 0.08). Age increased stroke risk for nondrinkers (p = 0.012) and decreased it for heavy drinkers (p = 0.040). Midlife heavy drinkers were at high risk from baseline until the age of 75 years, when hypertension and diabetes mellitus grew to being the more relevant risk factors. In analyses of monozygotic twin-pairs, heavy drinking shortened time to stroke by 5 years (p = 0.04).


Stroke-risk associated with heavy drinking (>2 drinks/d) in midlife seems to predominate over well-known risk factors, hypertension and diabetes, until the age of approximately 75 years and may shorten time to stroke by 5 years above and beyond covariates and genetic/early-life factors. Alcohol consumption should be considered an age-varying risk factor for stroke.


While of interest because it was performed in twins, that the assessment of mid-life alcohol and classic stroke risk factors was obtained only at baseline limits the ability to assess the significance and interaction between alcohol, tobacco, diabetes, and hypertension.

Clinical Topics: Prevention, Smoking

Keywords: Alcohol Drinking, Smoking, Stroke, Risk, Risk Factors, Twins, Monozygotic, Ethanol, Registries, Alcoholic Intoxication, Cardiovascular Diseases, Body Mass Index, Depression, Diabetes Mellitus

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