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Objectives This study examines the relationship between alcohol consumption and incident stroke among older adults and tests whether alcohol consumption contributes to observed race and sex differences in stroke. Method Data are from a U.S. national cohort of black and white adults aged 45 and older, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Current and past drinking levels were reported at baseline (2003-2007). Participants who had never had a stroke were followed for adjudicated stroke events through September 2015 (n = 27,265). We calculated Cox proportional hazard models for stroke, adjusting for demographic, socioeconomic, behavioral, and health characteristics. Results Participants, mean age 64.7 years, consumed on average 2.2 drinks/week and experienced 1,140 first-time stroke events over median 9.1 years follow-up. Nondrinkers had a 12% higher risk of stroke than current drinkers; the risk of stroke among nondrinkers largely reflected high risks among past drinkers; these differences were explained by socioeconomic characteristics. Among current drinkers, light drinkers had significantly lower stroke risks than moderate drinkers after accounting for demographic, socioeconomic, behavioral, and health characteristics. Implications of alcohol did not differ between blacks and whites but did differ by sex: Especially among women, nondrinkers, and specifically past drinkers, had higher risks; these differences were largely explained by health characteristics and behaviors. Alcohol did not explain race and sex differences in stroke incidence. Discussion Among older adults, those who used to, but no longer, drink had higher risks of stroke, especially among women; current light drinkers had the lowest risk of stroke.

Current definitions of hypertension are primarily based on systolic blood pressure (SBP) and diastolic blood pressure (DBP) but not on pulse pressure (PP). More recently, increased attention has been given to PP as a predictor of stroke risk, with PP hypothesized to be an indicator of the stiffness of large arteries, especially the aorta.1–4 SBP and DBP increase with age in a parallel manner until about age 60, after which SBP continues to rise and DBP begins to decrease. This age-related phenomenon results in the large increase in PP after age 60 and an increase in the prevalence of isolated systolic hypertension.5 As a result, PP may be a key blood pressure (BP) measure in older individuals and may be important as a risk factor for cardiovascular disease, including stroke, myocardial infarction (MI), and death.3 Some evidence suggests PP may be an independent predictor of stroke, even independent of SBP.6Although studies have explored a possible relationship between PP and occurrence of stroke events, most of these studies have included predominantly white populations.2,5 Few data on this subject are available in African-Americans (AA), and it is unclear if there is a correlation between PP and the incidence of stroke in this population. Differences in the association of PP and stroke between women and men have also been reported, but not extensively.1 The primary purpose of this study was to further investigate if PP is a useful predictor for stroke risk. We postulated that differences in PP, independent of SBP may represent one possible contributor to the racial differences in stroke risk. As such, The REasons for Geographic And Racial Differences in Stroke (REGARDS) could provide valuable information as to whether racial differences exist relative to PP, and its effect on incident stroke. We also explored whether AAs have a greater stroke risk at same PP compared with whites (that is a differential susceptibility compared with whites), and if regional differences in that association exist.