Earlier and worse strokes tied to heavy drinking

Researchers report that people drinking three or more alcoholic drinks per day are at a significantly greater risk of intracerebral hemorrhage (a type of stroke caused by bleeding in the brain) and at a younger age than people drinking less than three drinks a day.

They also found that heavy drinkers were more likely to have cerebral small vessel disease (damage to small blood vessels in the brain), a type of long-term brain damage.

They reported these findings on Nov. 4, 2025 in Neurology, an official journal of the American Academy of Neurology.

“Intracerebral hemorrhage is the most deadly type of stroke with cerebral small vessel disease being its leading cause,” said study author M. Edip Gurol, MD, of Harvard University in Boston and a member of the American Academy of Neurology. “While heavy drinking has been linked in previous studies to an increased risk of stroke, our findings suggest that it doesn’t just increase the severity of a bleeding stroke, it may also accelerate long-term harm to the brain’s small vessels.”

The investigators analyzed data collected from consecutive patients admitted with spontaneous, nontraumatic intracerebral hemorrhage (ICH) to Massachusetts General Hospital in Boston between 2003 and 2019.

They defined heavy alcohol consumption (HUA) as regular alcohol consumption of 3 or more drinks per day.

Among the 1,600 subjects, 851 were male, the median age was 75 years and 104 met criteria for heavy alcohol use.

When compared with the non-heavy alcohol use subjects, the heavy users were significantly younger at the onset of intracerebral hemorrhage (median 64 vs 75 years; p < 0.001) and had larger bleed volume (70% greater; p = 0.005.)

The heavy alcohol users were twice as likely to show evidence of bleeding in deep brain regions, and nearly twice as likely to show bleeding that spread into the brain’s fluid-filled spaces, a complication called intraventricular extension.

“These findings suggest that HAU may exacerbate acute ICH severity and accelerate long-term cerebral small vessel pathology,” the authors concluded.

“Reducing heavy alcohol use may not only lower a person’s risk of bleeding stroke, it may also slow the progression of cerebral small vessel disease, which in turn may reduce the chances of having another stroke, cognitive decline and long-term disability,” added Gurol. “Promoting lifestyle changes like quitting alcohol should be part of stroke prevention efforts, especially for those at higher risk.”