Jurnal Reading

Alcohol and Acute Ischemic

Stroke Onset

Pembimbing: dr. Hasymi Hanafiah, Sp. S

Penyaji
Suluh Bayu Waskito, S.Ked
Background and Purpose

?
Background and Purpose
Menguji hipotesis
bahwa konsumsi
alkohol dapat
menjadi resiko
stroke iskemik

case- crossover
approach

Variasi resiko
lamanya waktu dari berbagai
Munculnya
antara intake macam jenis
gejala
alkohol minuman
alkohol
Methods

January 2001
- November
2006
 Results
Reported
390 patients
248
(64%) 14
104
reported within 1 hour
alcohol within 24
of stroke
consumption hours
onset
in the prior
year
Conclusions

Resiko
munculnya
onset stroke
sementara
terlihat
meningkat pada
jam setelah
konsumsi
alkohol
 1st
hypothe
sis

Documented :

have acute
potentially
deleterious
physiological
effects within
hours after
consumption
 2nd Aktivit
hypothe as
sis Fibrin
sensiti olitik
vitas
insulin
dan Konsum Profil
adipo si lipid
kinesi alkohol
s dalam
jumlah
sedang
Solubl
e
efek Inflam
vascul
protekti mator
ar
f y
adhesi
marke
on
Flow- rs
molec
ules media
ted
vasodi Hours,
latatio weeks,
n or years
METHODS
 Study
Populatio
n

January
2001
-Novem
ber
2006
 Study
Populatio
n
0 - 14 days after
acute ischemic
stroke
(@35 45
minutes)
209 men
390 patients
interviewed
181 women
 Include
Charateri
stic

Neurologist-confirmed diagnosis of acute

ischemic stroke
English-speaking
Free of dementia
by
clinical diagnosis or appropriate imaging
studies
 Exclude
Charateri
stic Could not
identify the
time of onset of Cognitively
their stroke impaired
symptoms

Had poor
memory around
the time of the
stroke
Exclude
Experienced
aphasia
Unable to
complete the
structured Too ill to
interview complete the
structured
interview
 43%
Patients with confirmed ischemic
stroke met all inclusion criteria
12,5%
discharged
from the
hospital
5.5%
83% agreed before the
refused
interviewers
were able to
approach
them
?
Interview
Structured
questionnaire
Date and time
of first
symptoms

?
Asked patient
Consumed any
alcoholic
beverage in the
year before
their stroke
 last time
Ask consum
them ed an
alcoholic
? beverag
e

Patients Usual
Types of reported frequency
alcohol of
consume any alcohol
d (beer, alcohol consumpt
wine, or ion over
liquor) consump the prior
tion year

A serving size
Usual
of alcohol : number
12 ounces of of
servings
beer consume
4 ounces of wine d each
1,5 ounces of time
liquor straight or
in a mixed drink
 Also
ask this
?
Caffein
e
Sympto
ms on Cigaret
the day te
of the smokin
Last g,
stroke exposure
to other
potential marijua
triggers na
and usual
frequenc
y of
these
factors
Medica over the
tion prior
use Cocaine
year

Stress,
anger,
and
physica
l
activity
RESULTS
PRIOR YEARS
PRIOR
YEARS

Median Amounts =
Median
1 drink
Frequency =
(only 13 drinking > 2
2 times per week
servings)
 Founded

169 subjects
reported exposure
week before stroke

104 subjects
drank alcohol within Founded:
24
hours of stroke 1 hour after
onset alcohol
consumption,
the risk of
stroke onset
14 subjects
2.3 x higher :
drank within 1 hour of non use
stroke
onset
Alcohol
Type
Exposure
other
potensial
triggers
14 people exposed
248 participants
lo
exposed to alcohol
alcohol in the hour
in the prior
before stroke
year
onset

4
were also
63 participants
exposed
exposed to other
to vigorous
potential triggers
physical activity
in the hour before
stroke onset
1
drank a
caffeinated
beverage
DISCUSSION
In This
study
 found that moderate( 151

Hiilbo
to 300 g) and heavy
(>300 g) consumption of
alcohol within the week

m before stroke onset,

associated with a
significantly higher risk
of stroke
Other
Studies
after accounting for

Goreli
coexposures
including smoking, there
was no statistically

ck significant
increase in risk of
ischemic stroke in the 24
hours after
alcohol consumption
Previous Impaire
Study d
fibrinol
ysis

Modera
te and
Heart high Platelet
rate intakes activati
of on
alcohol

Blood
pressur
e
 Increasing
Heavy the
consumptio Dehydration transient
n risk of
stroke

However, such heavy

consumption was rare
and unlikely to
explain our findings
 Hendriks
and
colleagues
Clinical trial

Moderate drink (40 g)

alcohol
Plasminogen
activator
inhibitor
Was not
significantly
significantly
8 healthy men higher after
different after
40g of alcohol
9 hours
than water
after 1,3,
and 5 hours
 Fibrin
Other olytic
studies activit
Insuli y
n
sensiti
vity, Modera Lipid
and te profile
adipo consum
kinesi ption of
s alcohol

Solubl
e
protecti Inflam
vascul
ve mator
ar
effects y
adhesi
marke
on
Flow- rs
molec
ules media
ted
vasodi Hours,
latatio weeks,
n or years
 Other Studies

Heavy light to moderate

alcohol consumption:
consumption: no association with
ischemic decreased risk of
associated with an or hemoragic stroke ischemic stroke and
increased risk of a higher risk
ischemic and of hemorrhagic
hemorrhagic stroke stroke associated
with.
 Mukamal
and
colleagues

Light consumption (< 1drink daily)

Moderate alcohol consumption (1 to 2
drinks daily)
>2 drinks per day

Not
associated Protective
with stroke Increased
risk risk of
isehcmie
stroke
SUMMARY
Summa
ry

Short Term Long Term

Risk of ischemic ischemic stroke

stroke was risk appears to
transiently depend on:
elevated for 2 Frequency of
hours after alcohol
drinking as little consumption
as 1 serving of Quantity of
alcohol. alcohol
The risk rapidly consumption
returned to
baseline and
Thank You
SAY NO TO ALCOHOL DRINK