April 05, 2019
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Moderate alcohol intake increases BP, stroke risk in men

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In a genetic epidemiological study, the assumed protective effect of moderate alcohol consumption on CV events was noncausal, and any level of alcohol consumption was associated with increased BP and stroke risk in men.

“Using genetics is a novel way to assess the health effects of alcohol, and to sort out whether moderate drinking really is protective, or whether it’s slightly harmful,” Iona Y. Millwood, DPhil, from the Medical Research Council Population Health Research Unit at the University of Oxford, U.K., said in a press release. “Our genetic analyses have helped us understand the cause-and-effect relationships.”

The researchers analyzed 512,715 Chinese adults with documented levels of alcohol consumption from the China Kadoorie Biobank and followed them for approximately 10 years. Outcomes of interest included ischemic stroke, intracerebral hemorrhage and MI.

In addition, the researchers genotyped 161,498 participants for two variants that alter alcohol metabolism, ALDH2-rs671 and ADH1B-rs1229984.

Among the cohort, 33% of men and 2% of women reported drinking alcohol most weeks.

Drinking not protective

In men, according to self-reported alcohol intake, those who had one or two drinks per day (approximately 100 g per week) had lower risk for ischemic stroke, intracerebral hemorrhage and MI than those who drank more or those who drank not at all. However, genotype-predicted alcohol intake in men was not associated with a similar pattern, Millwood and colleagues wrote.

In a genetic epidemiological study, the assumed protective effect of moderate alcohol consumption on CV events was noncausal, and any level of alcohol consumption was associated with increased BP and stroke risk in men.
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Rather, as genotype-predicted alcohol intake in men rose, so did risk for ischemic stroke (RR per 280 g per week = 1.27; 95% CI, 1.13-1.43) and especially for intracerebral hemorrhage (RR per 280 g per week = 1.58; 95% CI, 1.36-1.84), according to the researchers.

There was no relationship between genotype-predicted alcohol intake in men and MI risk (RR per 280 g per week = 0.96; 95% CI, 0.78-1.18).

Also in men, increases in usual alcohol intake and genotype-predicted alcohol intake corresponded with increases in BP (P < .0001 for all), according to the researchers.

In women, the genotypes did not predict elevated alcohol intake and were not associated with BP, stroke or MI, Millwood and colleagues wrote.

“There are no protective effects of moderate alcohol intake against stroke. Even moderate alcohol consumption increases the chances of having a stroke,” Zhengming Chen, DPhil, from the Clinical Trial Studies Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, said in the release. “The findings for heart attack were less clear-cut, so we plan to collect more evidence.”

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Further trials unethical

In a related editorial, Shiu Lun Au Yeung, PhD, and Tai Hing Lam, PhD, both from the School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, wrote, “Considering that this study by Millwood and colleagues and a previous analysis cast doubts about the net protective effects of moderate drinking and the 2016 Global Burden of Disease Study showed harms at all levels of alcohol use, further trials would be unethical.” – by Erik Swain

Disclosures: The study was funded in part by GlaxoSmithKline. Chen and Millwood report receiving funding from GlaxoSmithKline during the conduct of the study. Please see the study for the other authors’ relevant financial disclosures. Lam and Yeung report no relevant financial disclosures.