In a meta-analysis of 35 obser- consumption of 60 g alcohol per day was associated with a 64% increased risk for all stroke (RR, 1.64; 95% CI, 1.39 1.93), a 69% increase for ischemic stroke (RR, 1.69; 95% CI, 1.34 2.15), and more than doubling for hemor- rhagic stroke (RR, 2.18; 95% CI, 1.48 3.20). Consumption of <12 g/d was associated with a reduced risk of total (RR, 0.67 0.96) stroke, with consumption of 12 to 24 g/d associ- ated with a lower risk of ischemic stroke (RR, 0.72; 95% CI, 0.57 0.91). A systematic review of triggers of ischemic stroke showed a significant association between ischemic stroke and alcohol abuse of >40 to 60 g within the preceding 24 hours (OR, 2.66; 95% CI, 1.54 4.61) or >150 g within the previous Alcohol Consumption: Summary and Gaps In observational studies, light to moderate alcohol consump- tion is associated with reduced risk of total and ischemic stroke, whereas heavier alcohol consumption increases stroke risk. Prospective, randomized, clinical trials showing that reduction of heavy alcohol consumption reduces risk or that light alcohol consumption is beneficial are lacking and are ethically untenable because it is well established that alcohol dependence is a major health problem. Alcohol Consumption: Recommendations 1. Reduction or elimination of alcohol consumption in heavy drinkers through established screening and counseling strategies as described in the 2004 US Preventive Services Task Force update is recom- (Class I; Level of Evidence A). 2. For individuals who choose to drink alcohol, con- sumption of 2 drinks per day for men and 1 drink per day for nonpregnant women might be reason- (Class IIb; Level of Evidence B). 