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WHEELING, W.Va., June 25 -- Fatal hemorrhagic strokes were more than three times as common in men who had at least six drinks daily, researchers found.

In a cohort of more than 6,000 participants, men who admitted to such heavy drinking had an adjusted hazard ratio for death from hemorrhagic stroke of 3.39 (95% CI 1.38 to 8.35) compared with nondrinkers, reported Heechoul Ohrr, MD, PhD, of Yonsei University in Seoul, and colleagues.

But binge drinking on a less-than-daily basis -- even multiple times per week -- did not appear to increase the risk of death from hemorrhagic stroke or other cardiovascular events, the researchers also reported online in the American Heart Association journal Stroke.

They said the results were similar to earlier findings from Finland and Russia, two other countries where binge drinking is common.

More than 20% of the male study participants told the investigators that they sometimes consumed six or more drinks on one occasion, classifying them as binge drinkers.

Surveys in the U.S. have found a corresponding percentage of about 3.5% (though much higher among young adults).

Dr. Ohrr and colleagues analyzed data from the rural Kangwha county cohort first assembled in 1985 with participants who were at least 55 at the time. Those with a history of stroke were excluded, leaving 2,624 men and 3,533 women who were then followed for almost 21 years.

Participants were interviewed at baseline and in 1994 about their drinking habits and health history and status. Physical exams were also given at baseline.

Data on fatal outcomes were obtained from a national database starting in 1992 and, for those who died before that, from death records or calls to surviving relatives.

Only 0.5% of women participants were classified as binge drinkers, which is why the study focused mainly on men.

In addition to the association with hemorrhagic stroke fatalities, daily binge drinking had significantly higher rates of death from atherosclerotic disease (HR 1.73, 95% CI 1.15 to 2.62) and total stroke (HR 1.86, 95% CI 1.16 to 2.99), as well as all-cause mortality (HR 1.33, 95% CI 1.11 to 1.60).

There was no significant relationship between daily bingeing and deaths from ischemic stroke, hypertensive disease, or ischemic heart disease.

But most types of fatal cardiovascular events occurred only in small numbers among the daily binge drinkers, of whom there were 182 in the cohort. There was only one death from ischemic stroke, two from ischemic heart disease, and five from hypertensive disease.

Among 50 participants who reported binge drinking "a few times a month" and 302 who said they binged "a few times a week," there were no significant increases in cardiovascular deaths or all-cause mortality compared with nondrinkers, Dr. Ohrr and colleagues found.

Death rates were adjusted for age, history of chronic disease, smoking, body mass index, hypertension, and educational status.

When the researchers looked at all male drinkers, not just those who reported bingeing, they found little relationship between frequency of drinking and cardiovascular deaths.

Daily drinkers had an adjusted hazard ratio for death from atherosclerotic disease of 1.36 (95% CI 1.00 to 1.84), relative to nondrinkers.

Total stroke deaths may also have been increased in the daily drinkers (HR 1.40, 95% CI 0.97 to 2.01).

All-cause mortality was definitely higher among daily drinkers (HR 1.25, 95% CI 1.10 to 1.43).

Participants who said they drank less frequently showed no difference in risk relative to teetotalers.

Most drinkers in the study said their main beverages were a distilled liquor called soju, which is about 25% ethanol, or a fermented drink, makkoli, with an alcohol content similar to that of Western beer.

Dr. Ohrr and colleagues noted that their design did not allow them to correlate quantity of alcohol consumption with event risks.

So, they had no data on whether moderate consumption of alcohol had the protective effect against some cardiovascular events seen in other studies.

But many of those studies had indicated that the protective effect applied primarily to ischemic events. Those that examined hemorrhagic stroke have generally found a positive relationship with alcohol consumption, the researchers said.

Larry Goldstein, MD, a well-known stroke neurologist at Duke University, said the Korean researcher's findings were highly plausible and applicable to non-Asian populations.

He said they pointed in the same direction as earlier studies in largely Caucasian samples.

Dr. Goldstein noted that these studies were observational and therefore "subject to a variety of potential biases," but the consistency in the results suggested the findings are real.

"I think the relationship [between heavy drinking and hemorrhagic stroke] is now pretty well established," he said.

The authors noted several limitations of the study including the collection of the data about alcohol consumption via questionnaire and the fact that alcohol consumption was likely to change over the follow-up period of 20 years.

The study was funded by the Korea Science and Engineering Foundation. No relevant conflicts of interest were reported by study authors or Dr. Goldstein.

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