The impact of alcohol consumption on stroke prognosis: a systematic review and meta-analysis

Stroke imposes a substantial global burden. Alcohol consumption is an important and potentially modifiable risk factor, yet its impact on stroke prognosis across different follow-up periods and stroke types remains inconsistent across studies. This study aimed to systematically evaluate the association between alcohol consumption and stroke prognosis, across various follow-up durations and stroke subtypes. We systematically searched multiple databases, including PubMed, Web of Science, Embase and others, for relevant studies published from inception to January 2024. we included 58 studies and evaluated their methodological quality using the Newcastle-Ottawa Scale (NOS). Given the substantial heterogeneity among studies, we employed a random-effects model for the meta-analysis. Alcohol consumption significantly impacts stroke prognosis across various follow-up periods and stroke types. At short-term follow-up, it elevates the risk of poor prognosis in stroke patients (OR 1.62; 95% CI 1.32–1.99). In short- to medium-term follow-up, alcohol consumption is associated with increased risks of stroke recurrence (OR 1.40; 95% CI 1.10–1.78) and poor prognosis (OR 1.74; 95% CI 1.21–2.49). Long-term follow-up reveals a heightened risk of death in stroke patients who consume alcohol (OR 5.14; 95% CI 1.96–13.49). When categorizing strokes into ischemic and hemorrhagic types, alcohol consumption poses significant risks. It increases the risk of poor prognosis in ischemic stroke patients (OR 1.51; 95% CI 1.23–1.86), while also raising the risk of death (OR 1.77; 95% CI 1.26–2.48) and poor prognosis in patients with hemorrhagic stroke (OR 1.88; 95% CI 1.22–2.91). Alcohol consumption was associated with an elevated relative risk of mortality, recurrence, or poor prognosis in stroke patients across different stroke types and during specific follow-up periods. Future studies should more fully explore the effect of alcohol consumption on stroke prognosis in different populations and under different regions.