Heavy Alcohol Use Linked to Larger, Earlier Brain Bleeds
Key Clinical Summary
- In 1600 consecutive patients with spontaneous, nontraumatic intracerebral hemorrhage (ICH) at Massachusetts General Hospital (2003–2019), 7% reported heavy alcohol use (≥3 drinks/day).
- Heavy drinkers had brain bleeds 70% larger, at a median onset age of 64 vs 75 years, with doubled odds of deep or intraventricular hemorrhage.
- MRI data (n=1195) showed heavy alcohol use independently associated with severe white matter hyperintensities (aOR 3.04) and hypertensive small vessel disease (aOR 1.82), per Neurology (Massachusetts, USA).
In consecutive patients with spontaneous, nontraumatic brain bleeds, consuming 3 or more alcoholic drinks a day was associated with more severe brain bleeds and long-term vessel damage at an earlier age, according to a study published in Neurology.
“The brain bleed is one of the most lethal and disabling conditions known to human beings,” said corresponding author M. Edip Gurol, MD, of Massachusetts General Brigham and Harvard Medical School, Boston, Massachusetts, in a news release. “They come on suddenly, cause severe damage, and often leave patients with life-changing disabilities. It’s one of the most difficult conditions to recover from.”
The study included 1600 patients at Massachusetts General Hospital with spontaneous, nontraumatic intracerebral hemorrhage (ICH) between 2003 and 2019. Researchers investigated associations between acute ICH and heavy alcohol use, defined as 3 or more drinks per day.
Among the patients, 7% reported heavy alcohol use. Those patients were a median 64 years at brain bleed onset compared with a median 75 years for patients who reported drinking less than 3 drinks per day, according to the study. Additionally, patients with heavy alcohol use had brain bleeds about 70% larger than patients without heavy alcohol use, and they had double the odds of a bleed deep inside the brain or a bleed that spread into the fluid-filled spaces in the brain.
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Among 1195 patients who underwent magnetic resonance imaging (MRI), an analysis of markers of cerebral small vessel disease (cSVD) identified independent associations between heavy alcohol use and severe white matter damage (researchers reported an adjusted odds ratio of 3.04) and a hypertensive cSVD pattern (adjusted odds ratio of 1.82). Heavy alcohol use was also linked with lower platelet counts and higher blood pressure at hospital admission.
“We now know that heavy drinking leads to larger, earlier brain bleeds,” Dr Gurol said. “Minimizing or stopping alcohol use is an important step to lower that risk. Even for people at relatively low brain bleeding risk, limiting alcohol consumption to no more than 3 drinks per week may be an effective measure to protect against all types of stroke and to preserve both brain and cardiovascular health.”
Researchers noted several study limitations — including the small number of patients with self-reported heavy alcohol use, its cross-sectional design, and MRI use in only subset of patients — and recommended further research.
“Future studies should clarify alcohol-related mechanisms underlying cSVD progression and ICH severity,” they wrote, “and inform prevention strategies.”
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