Alcohol and stroke: Does minimal to moderate consumption have a protective effect?

It is now increasingly recognized that mild to moderate consumption of alcohol is associated with reduced mortality and coronary heart disease. Alcohol consumption and mortality follows a J-shaped association, with increasing mortality in heavy drinkers. There is some evidence from epidemiological studies that mild to moderate alcohol consumption may also reduce the risk of ischemic stroke and overall stroke in persons over 40 years of age. However, these studies have been criticized for not adequately considering possible confounding factors. Moreover, alcohol consumption is associated with an increased risk of intracerebral and subarachnoid hemorrhage,and binge drinking is a strong risk factor for both ischemic and hemorrhagic stroke. Alcohol consumption probably has no beneficial effects in young subjects. On the basis of the current evidence, it is notjustified to advise an otherwise healthy, mild to moderate consumer of alcoholic beverages to quit drinking. However, it seems premature to advise alcohol consumption generally for prevention of stroke.