Apolipoprotein E, Alcohol Consumption, and Risk of Ischemic Stroke: The Framingham Heart Study Revisited

Background: Data on the association between alcohol consumption and ischemic stroke have been inconsistent. It is not known whether allele ε₄ of the apolipoprotein E (apoE) gene modifies the alcohol-stroke association. We sought to examine whether ε₄ allele of the apoE gene influences the association between alcohol consumption and ischemic stroke or high-density lipoprotein (HDL) cholesterol. Methods: We examined a cohort of 7676 person-observations of the Framingham Heart Study. Incident stroke was ascertained by standardized methods. We used Cox proportional hazard model to estimate hazard ratios of ischemic stroke. Results: The average age at baseline was 63 years and 55% of the participants were women. During a mean follow-up of 7.4 years, 222 new cases of ischemic stroke occurred (56 embolic and 166 atherothrombotic events). Comparing current drinkers with nondrinkers, multivariable adjusted hazard ratio (95% confidence interval) for ischemic stroke was 0.50 (0.24-1.07) in the absence of ε₄ allele and 0.70 (0.24-2.05) in the presence of ε₄ allele (P for interaction = .64) for those younger than 65 years. Similarly, we did not observe a statistically significant interaction between ε₄ allele and alcohol consumption on the risk of stroke among people aged 65 years and older (P for interaction = .17). Alcohol consumption was positively associated with HDL cholesterol independent of ε₄ allele and age. Conclusions: Our data do not provide evidence for an interaction between ε₄ allele and alcohol consumption on the risk of ischemic stroke in this population. Furthermore, apoE polymorphism did not influence the alcohol-HDL relation.