Background
Methods
De novo cohort analyses
Study cohorts and participants
Statistical analysis
Systematic review and meta-analysis
Search strategy and study selection
Data extraction and quality assessment
Data synthesis
Results
Associations of alcohol consumption with mortality and cardiovascular morbidity in study cohorts
HSE/SHeSs | UK Biobank | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Never drinker | Former drinker | Low-level drinker | Medium-level drinker | High-level drinker | Overall | Never drinker | Former drinker | Low-level drinker | Medium-level drinker | High-level drinker | Overall | |
N | 263 (9.4) | 383 (13.7) | 1630 (58.2) | 458 (16.3) | 68 (2.4) | 2802 (100.0) | 1076 (7.5) | 1207 (8.4) | 5989 (41.6) | 5222 (36.3) | 892 (6.2) | 14386 (100.0) |
Age, mean (SD), y | 69.0 (11.0) | 67.1 (11.1) | 68.2 (10.1) | 64.2 (10.9) | 60.4 (10.7) | 67.3 (10.6) | 61.6 (6.6) | 61.1 (6.5) | 61.9 (6.1) | 61.6 (6.0) | 60.5 (6.4) | 61.6 (6.2) |
Alcohol intake, mean (SD), g/day | 0.0 | 0.0 | 4.0 (4.3) | 28.0 (10.2) | 85.1 (33.0) | 9.0 (16.9) | 0.0 | 0.0 | 7.9 (5.1) | 30.6 (10.6) | 76.7 (26.4) | 19.2 (21.4) |
BMI, mean (SD), kg/m2 | 28.5 (5.5) | 28.6 (5.7) | 27.9 (4.6) | 27.9 (4.1) | 28.0 (4.2) | 28.1 (4.8) | 30.0 (5.8) | 30.2 (6.0) | 29.1 (5.0) | 28.8 (4.3) | 29.0 (4.7) | 29.2 (4.9) |
Female | 187 (71.1) | 189 (49.3) | 758 (46.5) | 65 (14.2) | 5 (7.4) | 1204 (43.0) | 619 (57.5) | 447 (37.0) | 2242 (37.4) | 743 (14.2) | 174 (19.5) | 4225 (29.4) |
Smoking status | ||||||||||||
Never | 157 (59.7) | 89 (23.2) | 527 (32.3) | 78 (17.0) | 10 (14.7) | 861 (30.7) | 704 (65.4) | 350 (29.0) | 2616 (43.7) | 1512 (29.0) | 178 (20.0) | 5360 (37.3) |
Ex-smoker | 66 (25.1) | 191 (49.9) | 799 (49.0) | 272 (59.4) | 29 (42.6) | 1357 (48.4) | 252 (23.4) | 638 (52.9) | 2799 (46.7) | 3045 (58.3) | 507 (56.8) | 7241 (50.3) |
Current smoker | 40 (15.2) | 103 (26.9) | 304 (18.7) | 108 (23.6) | 29 (42.6) | 584 (20.8) | 120 (11.2) | 219 (18.1) | 574 (9.6) | 665 (12.7) | 207 (23.2) | 1785 (12.4) |
History of diabetes | 40 (15.2) | 74 (19.3) | 169 (10.4) | 43 (9.4) | 2 (2.9) | 328 (11.7) | 280 (26.0) | 346 (28.7) | 1026 (17.1) | 676 (12.9) | 117 (13.1) | 2445 (17.0) |
History of hypertension | 50 (19.0) | 60 (15.7) | 224 (13.7) | 54 (11.8) | 6 (8.8) | 394 (14.1) | 637 (59.2) | 764 (63.3) | 3193 (53.3) | 2940 (56.3) | 536 (60.1) | 8070 (56.1) |
Socioeconomic positiona | ||||||||||||
Low | 106 (40.3) | 186 (48.6) | 764 (46.9) | 230 (50.2) | 26 (38.2) | 1312 (46.8) | NA | NA | NA | NA | NA | NA |
Intermediate | 104 (39.5) | 138 (36.0) | 494 (30.3) | 83 (18.1) | 24 (35.3) | 843 (30.1) | NA | NA | NA | NA | NA | NA |
High | 53 (20.2) | 59 (15.4) | 372 (22.8) | 145 (31.7) | 18 (26.5) | 647 (23.1) | NA | NA | NA | NA | NA | NA |
Highest educational qualificationb | ||||||||||||
None | NA | NA | NA | NA | NA | NA | 432 (40.1) | 564 (46.7) | 1910 (31.9) | 1510 (28.9) | 247 (27.7) | 4663 (32.4) |
O levels or equivalent | NA | NA | NA | NA | NA | NA | 141 (13.1) | 150 (12.4) | 900 (15.0) | 742 (14.2) | 149 (16.7) | 2082 (14.5) |
A levels or equivalent | NA | NA | NA | NA | NA | NA | 315 (29.3) | 295 (24.4) | 1948 (32.5) | 1760 (33.7) | 305 (34.2) | 4623 (32.1) |
Degree | NA | NA | NA | NA | NA | NA | 188 (17.5) | 198 (16.4) | 1231 (20.6) | 1210 (23.2) | 191 (21.4) | 3018 (21.0) |
Cholesterol-lowering medications | 70 (26.6) | 128 (33.4) | 328 (20.1) | 107 (23.4) | 11 (16.2) | 644 (23.0) | 841 (78.2) | 990 (82.0) | 4876 (81.4) | 4488 (85.9) | 732 (82.1) | 11927 (82.9) |
Antihypertensive medications | 168 (63.9) | 247 (64.5) | 883 (54.2) | 217 (47.4) | 27 (39.7) | 1542 (55.0) | 746 (69.3) | 855 (70.8) | 4047 (67.6) | 3774 (72.3) | 651 (73.0) | 10073 (70.0) |
Antiplatelet agents | 118 (44.9) | 187 (48.8) | 725 (44.5) | 207 (45.2) | 23 (33.8) | 1260 (45.0) | 810 (75.3) | 902 (74.7) | 4655 (77.7) | 4305 (82.4) | 736 (82.5) | 11408 (79.3) |
Digoxin | 9 (3.4) | 19 (5.0) | 62 (3.8) | 10 (2.2) | 2 (2.9) | 102 (3.6) | 16 (1.5) | 29 (2.4) | 86 (1.4) | 66 (1.3) | 12 (1.3) | 209 (1.5) |
Warfarinc | NA | NA | NA | NA | NA | NA | 59 (5.5) | 106 (8.8) | 358 (6.0) | 313 (6.0) | 34 (3.8) | 870 (6.0) |
Characteristics of studies included in meta-analysis
Source | Country | Dataset | Sex | Study size, No. | Meta-analyses Inclusiona | Follow up, yb | Baseline age, yc | Reference group including former drinkers | Pre-/post-event alcohol assessment | Multiple alcohol measures | Quality assessment score | Primary event | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ACM case, No. | CVM case, No. | CVE case, No. | ||||||||||||
HSE/SHeSs | UK | HSE (1994–2008) / SHeSs (1995, 1998, 2003) | M, F | 2802 | 1257 | 492 | NA | 9.5 | 67.3 | Bothd | Post- | No | 9 | MI/angina, strokee |
UK Biobank | UK | Initial assessment visit (2006–2010) | M, F | 14,386 | 1640 | 631 | 2950 | 8.7 | 61.6 | Bothd | Post- | No | 9 | MI, angina, stroke |
Levantesi et al., 2013 [12] | Italy | GISSI study | M, F | 11,248 | 1656 | NA | 1168 | 5.7 | 59.4 | Yes | Post- | Yes | 7 | MI |
Pai et al., 2012 [13] | USA | Health Professionals Follow-up Study | M | 1818 | 468 | 243 | NA | Up to 20 | Range 40–75 | Yes | Both | Yes | 7 | MI |
Rosenbloom et al., 2012 [14] | USA | Onset study | F | 1253 | 441 | NA | NA | Up to 10 | 66.1 | Yes | Pre- | No | 9 | MI |
Janszky et al., 2008 [44] | Sweden | SHEEP study | M, F | 1332 | 259 | 140 | NA | 8.6 | 59.4 | No | Pre- | No | 9 | MI |
Masunaga et al., 2006 [41] | Japan | Consecutive patients | M | 3845 | NA | NA | 142 | 1.1 | 57.2 | No | Post- | No | 8 | MI |
Aguilar et al., 2004 [36] | USA, Canada | SAVE trial | M, F | 2036 | 355 | 284 | NA | 3.5 | 59.2 | Yes | Both | No | 7 | MI |
Jackson et al., 2003 [37] | USA | Physicians’ Health Study | M | 1320 | 369 | 267 | NA | 4.5 | 67.4 | Yes | Post- | No | 6 | Stroke |
de Lorgeril et al., 2002 [43] | France | Lyon Diet Heart Study | M | 353 | NA | NA | 104 | 4.0 | 54.0 | Yes | Post- | Yes | 7 | MI |
Mukamal et al., 2001 [45] | USA | Onset study | M, F | 1913 | 317 | 238 | NA | 3.8 | 61.8 | Yes | Pre- | No | 8 | MI |
Shaper et al., 2000 [46] | UK | British Regional Heart Study | M | 596 | 258 | 184 | NA | 12.8 | Range 45–64 | No | Post- | No | 9 | MI, angina |
Valmadrid et al., 1999 [56] | USA | WESDR | M, F | 163 | NA | 52 | NA | Up to 12.3 | 68.6 | No | Post- | No | 9 | MI/anginae, f |
Muntwyler et al., 1998 [38] | USA | Physicians’ Health Study | M | 5358 | 920 | NA | NA | 5.0 | 64.1 | Yes | Post- | No | 6 | MI |
Alcohol consumption and all-cause mortality among CVD patients
Outcome and subgroup | No. of studies (curves) | No. of patients | Maximal effect sizea | Reversion point, g/dayb | Powers for the Best-Fitting FP2 | ||
---|---|---|---|---|---|---|---|
RR (95% CI) | g/day | dose_1 | dose_2 | ||||
All-cause mortality | |||||||
Overall | 11 (11) | 41,743 | 0.79 (0.73–0.85) | 7 | 62 | −0.5 | 1 |
Male | 6 (6) | 19,897 | 0.82 (0.72–0.93) | 9 | 39 | 0 | 0.5 |
Female | 3 (3) | 6046 | 0.64 (0.36–1.14) | 54 | 49 | −2 | 3 |
MI as primary event | 9 (9) | 29,554 | 0.82 (0.68–0.99) | 2 | 7 | −1 | 0.5 |
Angina as primary event | 2 (2) | 8938 | 0.79 (0.63–0.99) | 39 | 46 | 0.5 | 3 |
Stroke as primary event | 3 (3) | 3618 | 0.71 (0.42–1.20) | 12 | NA | 0 | 0.5 |
Reference group including former drinkers | 9 (9) | 41,405 | 0.77 (0.69–0.85) | 16 | 75 | −0.5 | 2 |
Reference group excluding former drinkers | 4 (4) | 17,526 | 0.85 (0.71–1.00) | 3 | 3 | −0.5 | −0.5 |
Post-event alcohol assessment | 8 (8) | 37,245 | 0.81 (0.74–0.88) | 9 | 52 | 0 | 0.5 |
Multiple alcohol measures | 2 (2) | 12,337 | 0.78 (0.59–1.03) | 16 | NA | −0.5 | −0.5 |
Cardiovascular mortality | |||||||
Overall | 9 (9) | 24,770 | 0.73 (0.64–0.83) | 8 | 50 | 0 | 0.5 |
Male | 5 (5) | 14,536 | 0.72 (0.62–0.85) | 9 | 32 | 0 | 0.5 |
Female | 2 (2) | 4790 | 0.29 (0.09–1.01) | 54 | 54 | 0 | 2 |
MI as primary event | 6 (6) | 12,422 | 0.76 (0.64–0.91) | 3 | 25 | −2 | 3 |
Angina as primary event | 2 (2) | 8934 | 0.72 (0.42–1.23) | 56 | NA | 3 | 3 |
Stroke as primary event | 3 (3) | 3617 | 0.63 (0.37–1.08) | 26 | NA | 0 | 3 |
Reference group including former drinkers | 6 (6) | 24,269 | 0.73 (0.58–0.93) | 13 | 27 | 0 | 0.5 |
Reference group excluding former drinkers | 5 (5) | 17,683 | 0.71 (0.55–0.90) | 7 | 29 | −0.5 | 0.5 |
Post-event alcohol assessment | 7 (7) | 21,525 | 0.73 (0.60–0.90) | 8 | 43 | 0 | 0 |
Multiple alcohol measures | 1 (1) | 1818 | 0.58 (0.40–0.84) | 17 | 33 | −0.5 | 3 |
Cardiovascular events | |||||||
Overallc | 4 (5) | 28,621 | 0.50 (0.26–0.96) | 6 | 15 | −2 | −2 |
Male | 3 (4) | 13,598 | 0.56 (0.23–1.34) | 8 | NA | −2 | −2 |
Female | 1 (1) | 3775 | 0.67 (0.43–1.05) | 54 | 49 | −2 | 3 |
MI as primary event | 4 (5) | 20,361 | 0.79 (0.66–0.94) | 11 | 35 | −2 | 3 |
Angina as primary event | 1 (1) | 8747 | 0.69 (0.59–0.81) | 35 | n.a. | −2 | 1 |
Stroke as primary event | 1 (1) | 1855 | 0.49 (0.26–0.92) | 72 | n.a. | −2 | 3 |
Reference group including former drinkers | 3 (3) | 25,983 | 0.72 (0.53–0.97) | 40 | 45 | 1 | 1 |
Reference group excluding former drinkers | 2 (3) | 17,020 | 0.78 (0.46–1.31) | 17 | NA | 3 | 3 |
Multiple alcohol measures | 1 (1) | 353 | 0.32 (0.14–0.71) | 38 | n.a. | 2 | 3 |