Cirrhosis Could Raise Stroke Risk

Average yearly rate of the attacks doubled in people with the liver disease, study found

By Robert Preidt

Monday, June 5, 2017

MONDAY, June 5, 2017 (HealthDay News) -- Cirrhosis -- a stiffening of liver tissue that's often tied to excessive drinking of alcohol -- may also raise an older person's odds for a stroke, a new study suggests.

"In a nationally representative sample of elderly patients with vascular risk factors, cirrhosis was associated with an increased risk of stroke, particularly hemorrhagic stroke," wrote a team led by Dr. Neal Parikh, of Weill Cornell Medicine and New York-Presbyterian Hospital in New York City.

Hemorrhagic or "bleeding" stroke comprises about 13 percent of strokes and occurs when a blood vessel ruptures, according to the American Stroke Association. The majority of strokes (87 percent) are ischemic -- meaning they are caused by clots.

In the new study, Parikh's team tracked 2008-2014 data for more than 1.6 million Medicare patients older than 66.

The research showed that while just over 1 percent of people who did not have cirrhosis suffered a stroke during the average year, that number jumped to just over 2 percent for people with the liver disease.

The study couldn't prove that the cirrhosis actually caused any of the strokes. According to the authors, possible explanations for the association between cirrhosis and increased stroke risk include impaired clotting ability. Or, patients' heart risk factors may be exacerbated by cirrhosis and the underlying causes of cirrhosis, such as alcohol abuse, hepatitis C infection and metabolic disease, they said.

Two experts in stroke care weighed in on the findings, which were published June 5 in the journal JAMA Neurology.

Dr. Ajay Misra is chair of neurosciences at NYU Winthrop Hospital in Mineola, N.Y. He said that, in the past, doctors had thought that cirrhosis somehow helped lower a person's risk for clot-linked, ischemic stroke, but the new study "dispels" that myth.

And Dr. Anand Patel, a neurologist at Northwell Health's Neuroscience Institute in Manhasset, N.Y., noted that the degree of cirrhosis was important.

"The risk of stroke appears to [rise] in proportion to the severity of cirrhosis," he said.

Patel also pointed out that the study offers little information on how helpful blood thinner medications might be in helping people with cirrhosis avoid strokes.

Parikh's team said further research is needed to help "yield opportunities for stroke risk reduction and prevention" in these types of patients.

SOURCES: Ajay Misra, MD, chairman of neurosciences at NYU Winthrop Hospital, Mineola, NY; Anand Patel, MBBS, vascular neurologist, Northwell Health's Neuroscience Institute, Manhasset, NY; JAMA Neurology, news release, June 5, 2017

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