Can Moderate to Heavy Alcohol Use Raise Stroke Risk in Young Adults?

Young adults who do moderate to heavy drinking in their 20s and 30s are more likely to have a stroke in early adulthood.

Moderate to heavy alcohol consumption increased risk for incident stroke, especially hemorrhagic stroke, in young adults, according to study findings published in Neurology.

Researchers conducted a nationwide population-based study, obtaining data from the Korean National Health Insurance Service database on 1,536,668 young adults (71.5% men) between the ages of 20 and 39 years who underwent an initial national health examination between January 1, 2009 and December 31, 2012. The researchers only included young adults who received 4 consecutive annual health examinations between 2012 and 2015 following the initial examination.

The objective of the study was to examine the relationship between alcohol consumption and incident stroke, including ischemic and hemorrhagic subtypes, in this patient population during the follow-up period.

At each health examination, data was collected on alcohol consumption from a self-administered patient questionnaire, including the number of days per week and number of drinks per session. The researchers classified alcohol intake into 4 categories: none, mild (>0 and <105 g/wk), moderate (105-209 g/wk), and heavy (210 g/wk). Then, they calculated cumulative alcohol burden based on the sum of all points obtained at all 4 health examinations.

Over a median follow-up period of 6 years, incident stroke occurred in 3153 young adults (incidence rate: 0.37/1000 person-years), of whom 1773 experienced ischemic stroke (0.21/1000 person-years) and 1535 experienced hemorrhagic stroke (0.18/1000 person-years).

Reducing alcohol consumption should be emphasized in young adults with heavy drinking habits as part of any stroke prevention strategy.

Incident stroke increased as cumulative alcohol burden scores increased. Alcohol burden scores of 2, 3, and 4 (indicating alcohol intake of more than 105g/wk for 2, 3, and 4 years) associated with 19%, 22%, and 23% increased risk of stroke, respectively. In particular, cumulative alcohol burden scores of 2, 3, and 4 significantly correlated with increased risk for hemorrhagic stroke (30%, 42%, and 36%, respectively).

After analyzing the effect of comorbid conditions on stroke risk, hypertension, and obesity significantly attenuated the impact of cumulative alcohol burden on stroke risk in young adults.

“Young adults who engaged in moderate to heavy drinking exhibited a higher risk for incident stroke, especially hemorrhagic stroke,” the researchers stated. “Reducing alcohol consumption should be emphasized in young adults with heavy drinking habits as part of any stroke prevention strategy.”

Study limitations included lack of generalizability outside of the Korean population, potential selection bias, recall bias using self-reported questionnaires for data on alcohol intake, use of diagnostic codes to define comorbidities and outcomes, lack of data on educational level, and inability to compare complete abstinence with mild alcohol consumption based on cumulative scoring. The researchers also did not assess changing drinking patterns or newly diagnosed comorbidities.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Chung JW, Lee SR, Choi EK, et al. Cumulative alcohol consumption burden and the risk of stroke in young adults: A nationwide population-based study. Neurology. Published online November 2, 2022:10.1212/WNL.0000000000201473. doi:10.1212/WNL.0000000000201473