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Drinking three or more alcoholic beverages a day may raise the risk for spontaneous intracerebral hemorrhage at a much younger age than typical, researchers found.
These strokes occurred at an average age of 60 with such high alcohol consumption, 14 years earlier than seen without heavy drinking (P<,0.0001), Charlotte Cordonnier, MD, PhD, of the University of Lille Nord de France in Lille, France, and colleagues,
Heavy drinking also predicted a near doubling in 2-year mortality risk after a deep intracerebral hemorrhage before age 60, the group reported in the Sept. 11 issue of Neurology.
"Clinicians should keep in mind that alcohol has an impact on vital outcome among young patients with intracerebral hemorrhage," they wrote.
"Nevertheless, it only remains a risk factor and not a cause in itself," they cautioned.
Heavy drinking has consistently turned up as a risk factor for this type of stroke, but why hasn't been clear.
The researchers looked deeper into the link in the prospective, observational Prognosis of InTra-Cerebral Hemorrhage (PITCH) cohort of 562 consecutive adults with a spontaneous intracerebral hemorrhage at a single university hospital in France. CT scans were performed at admission in all patients.
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Head trauma, tumor, hemorrhagic transformation of an ischemic stroke, and other cases with clear causes were excluded.
Fully 25% of the cohort qualified as heavy drinkers of 300 g or more of alcohol per week, the equivalent of three drinks per day, which the researchers noted reflected the high prevalence of alcoholism in the region.
These patients were, on multivariate analysis:
Younger at their stroke (odds ratio 0.97 for each year of age, 95% CI 0.95 to 0.98)
Less likely to have a history of ischemic heart disease (OR 0.34, 95% CI 0.15 to 0.77)
More likely to be smokers (OR 3.96, 95% CI 2.43 to 6.46)
Complications and hospital length of stay were similar between groups. Prevalence of living independently post-hemorrhage didn't differ significantly either.
However, hemorrhage characteristics were different for the heavy drinkers. Compared with intracranial hemorrhage patients with more moderate habits or no alcohol consumption, independent factors based on an imaging-based model were:
Nonlobular location in the brain (OR 1.71, 95% CI 1.05 to 2.77)
Less severe diffuse white matter abnormalities on CT (OR 0.76 per one-step increase, 95% CI 0.62 to 0.73)
Lower prothrombin ratio (P=0.017)
With regard to 2-year mortality, heavy alcohol intake was predictive of death among patients younger than age 60 with a nonlobar intracerebral hemorrhage (HR 1.96, 95% CI 1.06 to 3.63). However, heaving drinking did not influence outcomes in patients with lobar hemorrhages that were older or younger than 60.
The higher likelihood of deep or posterior fossa locations, suggested a link with small-vessel disease, the researchers noted.
"Regarding management, there might be a place for hemostatic strategies in the acute phase among young patients with deep intracranial hemorrhage and alcohol abuse," they wrote.
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The group cautioned that drinkers may have under-reported their alcohol intake, which could have contributed bias and underestimated the influence of heavy consumptions.
From the American Heart Association:
Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner