Heavy alcohol intake as a risk factor for rupture of intracranial aneurysm: a systematic review and meta-analysis

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Abstract Background Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological condition associated with high morbidity and mortality. Identifying modifiable risk factors, such as heavy alcohol intake, is vital for developing effective prevention and screening strategies. Objective To evaluate the association between heavy alcohol consumption and the risk of rupture in intracranial aneurysms. Methods A systematic review and meta-analysis were conducted following MOOSE and Cochrane guidelines. Databases including PubMed, SCOPUS, CENTRAL, MEDLINE (Ovid), EMBASE, and CINAHL were searched through October 2024. Observational studies and clinical trials involving adult humans were included. To minimize heterogeneity, heavy intake was defined as the highest consumption category reported by each study (typically >300g/week or >3 drinks/day). Risk of bias was assessed using the ROBINS-I tool, and study quality was evaluated via the Newcastle-Ottawa Scale. The meta-analysis was performed using Review Manager 5.3. Results Twenty-one studies comprising 680,233 participants and 5,243 confirmed aSAH cases were included. Heavy alcohol intake was associated with a significantly increased risk of aneurysm rupture (OR 2.25 [95% CI: 1.71–2.97]; p < 0.00001). Moderate heterogeneity was observed (I2 = 64.2%), likely reflecting variations in intake definitions across regions. Subgroup analysis revealed higher risk estimates in case-control studies (OR 2.39 [95% CI: 1.41–4.05]) compared to prospective cohorts (OR 1.99 [95% CI: 1.57–2.51]). No significant publication bias was detected (Egger’s test p = 0.322). Conclusion Heavy alcohol consumption is a potent, modifiable risk factor significantly associated with the rupture of intracranial aneurysms. Clinical management should prioritize alcohol cessation counseling as an essential component of preventive care for populations at risk of cerebral aneurysm to reduce the incidence of life-threatening aSAH.

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