Original Article
Prestroke Alcohol Consumption and Smoking Are Not Associated with Stroke Severity, Disability at Discharge, and Case Fatality

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.08.006Get rights and content

Background

Heavy alcohol consumption and smoking are known risk factors for stroke, but their influence on stroke severity and outcome may also be important. We tested if alcohol consumption and smoking relate to initial stroke severity, disability at discharge from hospital, and outcome at 30 days and at 1 year in 1049 patients of the Mures–Uzhgorod–Debrecen database.

Methods

Initial stroke severity was scored by the National Institutes of Health Stroke Scale. Case fatality and the modified outcome scale of the First International Stroke Trial were used to assess outcome. We used multiple regression analysis.

Results

Before their stroke, 24.5% were smokers and 24.7% admitted regular alcohol consumption. Neither smoking nor alcohol consumption status was associated with initial stroke severity. Case fatalities at discharge, at 30 days, and at 1 year were 12.2%, 16.9%, and 28.3%, respectively. Initial stroke severity, hemorrhagic subtype, and age in men over 60 years were strong predictors of outcome. We did not find significant difference among alcohol consumers and nonconsumers in 30-day and in 1-year case fatality in all stroke patients and in ischemic stroke patients. In hemorrhagic stroke, there was a nonsignificant tendency for higher case fatality among alcohol consumers (39.5% versus 26.4%, P > .2, at 30 days and 48.8% versus 35.8%, P > .2, at 1 year). Smoking did not influence significantly the outcome at 30 days and at 1 year.

Conclusion

Despite being risk factors, prestroke smoking and alcohol consumption do not have a significant influence on stroke severity and on short- and long-term outcome.

Introduction

In 2002, the World Health Organization estimated that there were 15.3 million strokes worldwide, more than a third of which (5.5 million) resulted in death.1 Stroke is expected to become a more prevalent cause of disability in the future because of the aging of the population.2 High stroke mortality rates in the Central–Eastern European region has been consistently reported.3, 4 Smoking is an independent risk factor of stroke,5 and the rate of smokers is higher in Central European than in the Western countries.6 It is generally accepted that although mild-to-moderate alcohol consumption reduces the risk of ischemic stroke, heavy drinking increases the risk for all subtypes of stroke.7, 8 Similar to smoking, alcohol consumption and alcohol-related premature death rate are higher in Central European countries compared with the Western countries.9, 10 In addition, the contaminants in homemade spirits in Eastern Europe also contribute to alcohol-related morbidity.11 Although it is clear that both heavy alcohol consumption and smoking are risk factors for stroke, the effect of prestroke smoking and alcohol consumption on stroke severity and outcome has been less extensively studied. We assumed that the higher rate of smoking and alcohol consumption may have an influence on high stroke mortality in the Central European region not only by increasing stroke risk but also by increasing stroke severity. For this reason, in a Central–Eastern European sample of over 1000 stroke patients from Hungary, Romania, and Ukraine, we tested whether stroke is, indeed, more severe and outcome is worse in smokers and in those who admit regular alcohol consumption.

Section snippets

The Database

The database of the Mures–Uzhgorod–Debrecen study12 was analyzed. Altogether 1049 patients are recorded in the database (603 men). The 3 participating stroke centers were university neurologic departments in Debrecen (Hungary, 210,000 inhabitants, 554 cases), Târgu Mures (Romania, 165,000 inhabitants, 261 cases), and Uzhgorod (Ukraine, 126,000 inhabitants, 234 cases). A standard case report form in the languages of the participating countries included age, gender, risk factors, neurologic

Distribution of Patients by Stroke Type, Smoking, and Alcohol Consumption

Stroke severity and case fatality for each patient category at 30 days and at 1 year are given in Table 1. Twenty patients (1.9%) had other confounding diagnoses (eg, sinus thrombosis). Those with subarachnoid hemorrhage (n = 46, 4.4%) were excluded, whereas those with transient ischemic attack were included in the ischemic stroke group in data analyses. Alcohol consumption was admitted by 24.7%, whereas 54.7% claimed themselves to be nonconsumer or light drinker, and there was no clear answer

Discussion

Plenty of data prove that initial stroke severity, age, and hemorrhagic stroke subtype are predictors of stroke outcome.17, 18, 19 Smoking and heavy alcohol consumption are well-known risk factors for stroke,7, 20, 21 but few studies examined the relationship between stroke severity or outcome and prestroke smoking status or alcohol consumption. By the analysis of close to a thousand acute stroke cases from 3 Central–Eastern European countries, we tested whether prestroke smoking or alcohol

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    Grant support: TAMOP-4.2.1.B-09/1/KMR.

    Competing interests: None.

    Authors' contributions: K.F. performed the primary data analysis and drafted the manuscript. S.S., I.S., C.S., and J.S. were responsible for data collection and database development in Romania. L.M., L.C., and D.B. managed data collection and the database in Hungary and L.M. also in Ukraine. V.S. assisted with data collection and management in Ukraine. L.K. performed the detailed final statistical analysis. D.B. and S.S. designed the study and prepared grant proposals for the study. D.B. was involved in data analysis and managed manuscript preparation with the coauthors and performed manuscript revisions. All authors read and commented on consecutive versions of the manuscript.

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