Alcohol Intake and Risk of Stroke: a Dose-response Meta-analysis

Background Stroke, as a major chronic non-communicable disease, seriously affects the health of the nation and imposes a heavy burden on patients, families and society. Alcohol consumption is common in China, and there is a close relationship between alcohol intake and stroke incidence, but the relationship between alcohol intake and stroke incidence is still controversial. Objective To investigate the relationship between alcohol intake and risk of stroke. Methods PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang Data, and SinoMed were searched for prospective cohort studies on the relationship between alcohol intake and risk of stroke from inception to December 2023. Literature screening, data extraction, and literature quality evaluation were performed independently by 2 researchers. Stata/MP 17.0 was used for dose-response meta-analysis. Results A total of 16 papers with 548 595 study subjects were included. Meta-analysis results showed that alcohol intake was associated with the risk of stroke (RR=1.17, 95%CI=1.10-1.26, P<0.05). The results of the subgroup analysis showed that the risk of stroke was increased by 10% for alcohol intake <20 g per day (RR=0.90, 95%CI=0.85-0.95, P<0.05) ; alcohol intake >40 g increased the risk of stroke by 35% (RR=1.35, 95%CI=1.23-1.49, P<0.05) ; alcohol intake increased the risk of hemorrhagic stroke by 49% (RR=1.49, 95%CI=1.14-1.95, P<0.05), alcohol intake ischemic stroke risk increased by 20% (RR=1.20, 95%CI=1.00-1.43, P<0.05) ; alcohol intake in Asian populations increased the risk of stroke incidence by 27% (RR=1.27, 95%CI=1.14-1.40, P<0.05) ; intake alcohol in men increased the risk of stroke by 19% (RR=1.19, 95%CI=1.09-1.29, P<0.05). Dose-response Meta-analysis showed a J-shaped nonlinear relationship between alcohol intake and risk of stroke (P=0.018), and the relative risk ratios of stroke for alcohol intake in drinkers compared with never-drinkers were 1 g/d: RR=0.97, 95%CI=0.96-0.98; 2 g/d: RR=0.96, 95%CI=0.94-0.97; 3 g/d: RR=0.95, 95%CI=0.93-0.97; 4 g/d: RR=0.94, 95%CI=0.91-0.96; 5 g/d: RR=0.91, 95%CI=0.88-0.94; 6 g/d: RR=0.90, 95%CI=0.86-0.93; 7 g/d: RR=0.88, 95%CI=0.84-0.92; 8 g/d: RR=0.88, 95%CI=0.83-0.92; 9 g/d: RR=0.88, 95%CI=0.83-0.92; 10 g/d: RR=0.88, 95%CI=0.83-0.93; 11 g/d: RR=0.88, 95%CI=0.83-0.93; 12 g/d: RR=0.90, 95%CI=0.85-0.95; 13 g/d: RR=0.91, 95%CI=0.85-0.95; 14 g/d: RR=0.92, 95%CI=0.86-0.95; 15 g/d: RR=0.93, 95%CI=0.86-0.96; 16 g/d : RR=0.95, 95%CI=0.88-0.96; 17 g/d: RR=0.96, 95%CI=0.88-0.97; 18 g/d: RR=0.98, 95%CI=0.89-0.97; 19 g/d: RR=0.98, 95%CI=0.89-0.98; 20 g/d: RR=0.99, 95%CI=0.90-0.99, and drinkers with an average alcohol intake of <20 g per day showed a reduced risk of stroke (P<0.001) . Conclusion There is a J-shaped nonlinear dose-response relationship between alcohol intake and the stroke risk, with moderate alcohol intake negatively associated with stroke risk. The risk of stroke is lowest with an average alcohol intake of 7-11 grams per day.