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γ-Glutamyltransferase and risk of stroke: the EUROSTROKE project
  1. M L Bots1,2,
  2. J T Salonen3,
  3. P C Elwood4,
  4. Y Nikitin5,
  5. A Freire de Concalves6,
  6. D Inzitari7,
  7. J Sivenius8,
  8. A Trichopoulou9,
  9. J Tuomilehto10,
  10. P J Koudstaal11,
  11. D E Grobbee1,2
  1. 1Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands
  2. 2Julius Center for Patient Oriented Research, University Medical Centre Utrecht, Utrecht, the Netherlands
  3. 3Research Institute of Public Health, University of Kuopio, Kuopio, Finland
  4. 4Centre for Applied Public Health Medicine, University of Wales College of Medicine, Cardiff, UK
  5. 5Russian Academy of Medical Sciences Siberian Branch, Institute of Internal Medicine, Novosibirsk, Russia
  6. 6Neurology, Hospitais da Universidade de Coimbra, Coimbra, Portugal
  7. 7Neurological and Psychiatric Sciences, University of Florence, Florence Italy
  8. 8Department of Neurology, Kuopio University Hospital, Kuopio, Finland
  9. 9Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
  10. 10Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
  11. 11Neurology, University Hospital Rotterdam Dijkzigt, Rotterdam, the Netherlands
  1. Correspondence to:
 Dr M L Bots, Julius Centre for Patient Oriented Research, Universtiy Medical Centre, Utrecht, room D01.335, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands;


Background: Alcohol consumption has been implicated in the aetiology of stroke. As data on alcohol consumption obtained by questionnaire are susceptible to missclassification, this study evaluated the assocation between γ-glutamyltransferase (γ-GT), as a marker for alcohol consumption, and fatal, non-fatal, haemorrhagic and ischaemic stroke in three European cohort studies, participating in EUROSTROKE.

Methods: EUROSTROKE is a collaborative project among ongoing European cohort studies on incidence and risk factors of stroke. EUROSTROKE is designed as a nested case-control study. For each stroke case, two controls were sampled. Strokes were classified according to MONICA criteria or reviewed by a panel of four neurologists. At present, data on stroke and γ-GT were available from cohorts in Cardiff (57 cases), Kuopio (66 cases), and Rotterdam (108 cases).

Results: An increase in γ-GT of one standard deviation (28.7 IU/ml) was associated with an age and sex adjusted 26% (95% CI 5 to 53) increase in risk of stroke. Adjustment for confounding variables such as drug use, history of myocardial infarction, total cholesterol, and diabetes mellitus did not materially attenuate the association. The risk of haemorrhagic stroke increased linearly with increase in γ-GT. The association for cerebral infarction was not graded: the risk increased beyond the first quartile, and remained increased. The association of γ-GT with stroke was significantly stronger among subjects without diabetes mellitus compared with subjects with diabetes mellitus (no association observed).

Conclusion: This EUROSTROKE analysis showed that an increased γ-GT, as a marker of alcohol consumption, is associated with increased risk of stroke, in particular haemorrhagic stroke.

  • cohort
  • blood pressure
  • myocardial infarction
  • alcohol consumption
  • γ-GT
  • γ-glutamyltransferase

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  • Funding: EUROSTROKE is supported by grant BMH1-CT93–1786 from the European Community BIOMED I programme and by grant CIPD-CT94–0256 from the European Community PECO programme.