Alcohol, Stroke, and Functional Outcomes after Stroke
To better understand the relationship between alcohol consumption and functional outcomes from stroke, Boston researchers evaluated data from a subgroup of 21,860 male participants in the prospective Physicians’ Health Study. The sample included only those men who reported no history of stroke or transient ischemic attack (TIA) at baseline. Alcohol consumption fell into 5 categories: <1 drink per week, 1 drink per week, 2–4 drinks per week, 5–6 drinks per week, or ≥1 drink per day. Possible functional outcomes included TIA and modified Rankin Scale* (mRS) scores of 0–1, 2–3, or 4–6. Multinomial logistic regression was used to evaluate the relationship between alcohol consumption and functional outcomes.
- Over a mean follow-up period of 21.6 years, 766 TIAs and 1393 strokes (1157 ischemic, 222 hemorrhagic, and 14 of unknown type) occurred.
- Men who consumed 1 drink per week had the lowest risk for stroke when using men who consumed <1 drink per week as the reference category [relative risk (RR) for TIA, 0.96; RR for total stroke, 0.80 (p=0.03)].
- For functional outcomes after total stroke, the RR of having a more severe mRS score of 4–6 was 0.60 among men who consumed 1 drink per week compared with men who consumed <1 drink per week who did not experience a TIA or stroke. This finding was similar for both ischemic and hemorrhagic stroke.
- Higher alcohol consumption showed no association with functional outcome after stroke.
*Scale used to assess degree of disability or dependence in daily activities following a stroke. Scores range from 0 (no symptoms) to 6 (death).
Comments:
Contrary to an earlier report from this cohort, the risk of stroke did not decrease among consumers of alcohol except among those who consumed 1 drink per week. As the authors suggest, any protective effects of moderate drinking against stroke may be less important as the population ages, at which time other risk factors (e.g., hypertension, atherosclerosis) may have stronger effects. Only scores in the most severe functional outcome category (mRS scores of 4–6) were lower among patients who consumed 1 drink per week compared with those who consumed <1 drink per week. The investigators did not adjust for changes in alcohol intake over time.
R. Curtis Ellison, MD
Reference:
Rist PM, Berger K, Buring JE, et al. Alcohol consumption and functional outcome after stroke in men. Stroke. 2010;41(1):141–146.