Alcohol consumption and mortality among stroke survivors: A NHANES observational cohort study with mediation analysis

The long-term effects of alcohol consumption among stroke survivors are unclear. This study investigated the association between alcohol intake and all-cause and cardiovascular mortality, and whether inflammatory markers mediate this relationship. A total of 793 stroke survivors from the National Health and Nutrition Examination Survey 2005 to 2016 were classified by alcohol intake frequency. Mortality data were obtained from the National Death Index. Cox models estimated hazard ratios for mortality. Mediation analysis examined inflammatory biomarkers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, neutrophil-albumin ratio, white blood cell count). During follow-up, 313 participants died (86 cardiovascular deaths). Mild and moderate drinking were associated with reduced all-cause mortality compared to former drinkers (hazard ratio = 0.711 and 0.657, respectively; P < .05). No significant association was found with cardiovascular mortality. A J-shaped association was observed between alcohol use and all-cause death. Inflammatory markers showed minimal, nonsignificant mediation (≤8.2%). Light-to-moderate alcohol consumption was statistically associated with lower all-cause mortality among stroke survivors, while no significant association was observed for cardiovascular mortality. These findings represent observational associations based on the available data.