The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

Aims As part of a larger study to estimate the global burden of disease attributable to alcohol:

• ? to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and
• ? to combine exposure and risk estimates to determine regional and global alcohol‐attributable fractions (AAFs) for major disease and injury categories.

Design, methods, setting Systematic literature reviews were used to select diseases related to alcohol consumption. Meta‐analyses of the relationship between alcohol consumption and disease and multi‐level analyses of aggregate data to fill alcohol–disease relationships not currently covered by individual‐level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi‐level analyses with prevalence data. Findings Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed. Conclusions Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.     

Alcohol drinking patterns and biomarkers of coronary risk in the Spanish population

Background and aimsTo estimate the association between patterns of alcohol consumption and biomarkers of coronary heart disease (CHD) risk.Methods and resultsCross-sectional study among 10,793 individuals representative of the Spanish population aged ≥18 years. The threshold between moderate and heavy drinking was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of ≥80 g of alcohol in men and ≥60 g in women at any drinking occasion in the preceding 30 days. Analyses were performed with generalized linear models with adjustment for the main confounders, and results were expressed as the percentage change in the geometric mean (PCGM). Compared to non-drinkers, moderate and heavy drinkers had progressively higher serum HDL-cholesterol, with a PCGM ranging from 4.8% (95% CI: 3.7–6.0%) in moderate drinkers without binge drinking (MNB) to 9.6% (5.1–14.2%) in heavy drinkers with binge drinking (HB). Fibrinogen decreased progressively with alcohol intake, from −2.2% (−3.1 to −1.3%) in MNB to −5.8% (−9.4 to −2.0%) in HB. Leptin, glycated hemoglobin and the HOMA-index also decreased with increasing alcohol intake, and particularly with binge drinking.ConclusionsModerate alcohol intake is associated with improved HDL-cholesterol, fibrinogen and markers of glucose metabolism, which is consistent with the reduced CHD risk of moderate drinkers in many studies. Heavy and binge drinking were also associated with favorable levels of CHD biomarkers; since these drinking patterns produce substantial health harms, our results should not be used to promote alcohol consumption.     

Alcohol use and prognosis in patients with coronary heart disease

Substantial evidence has shown that moderate drinkers have lower rates of coronary heart disease (CHD) than abstainers, but the effects of alcohol consumption among patients with established CHD are less clear. Alcohol intake has important effects on risk factors for reinfarction, including higher levels of high-density lipoprotein cholesterol and triglycerides, lower levels of fibrinogen and other prothrombotic factors, lower fibrinolytic potential, and antiplatelet activity. Studies of patients at risk for CHD, such as those with diabetes, hypertension, and hyperlipidemia, have shown that the association of moderate drinking and CHD is at least as strong as it is in the general population. Most recently, studies have found that survivors of acute myocardial infarction who drink moderately have a risk of death approximately 20%–30% lower than do abstainers or rare drinkers. Nonetheless, the risks and benefits of alcohol use remain complex, even among patients with CHD, and no simple recommendation regarding alcohol consumption can be made for all patients.     

Alcohol consumption and mortality. I. Characteristics of drinking groups

Aims. This is the first of a set of three papers evaluating drinking status and mortality risk. Analyses of multiple studies describe associations of drinking patterns with characteristics hypothesized to confound the relationships between drinking status and mortality. Characteristics which both significantly differentiate drinking groups and are consistent across studies would suggest that mortality studies not controlling for them may be compromised. Design and participants. Associations are evaluated from the raw data of 10 general population studies which contained mortality data. Long-term abstainers are compared to former drinkers, long-term abstainers and former drinkers are compared to light drinkers (by quantity, frequency and volume in separate analyses) and moderate to heavy drinkers are compared to light drinkers. Tetrachoric correlation coefficients assess statistical significance; meta-analysis determines if associations are homogeneous across studies. Measurements. Measures of alcohol consumption are quantity, frequency and volume; long-term abstainers are differentiated from former drinkers. Multiple measures of health, social position, social integration and mental health characteristics are evaluated. Findings. Across studies, adult male former drinkers are consistently more likely to be heavier smokers, depressed, unemployed, lower SES and to have used marijuana than long-term abstainers. Adult female former drinkers are consistently more likely to be heavier smokers, in poorer health, not religious, and unmarried than long-term abstainers. Both types of abstainers tend to be of lower SES than light drinkers and report poorer health (not consistent). Female abstainers are more likely to be of normal or overweight than light drinkers. Conclusions. Characteristics of two groups of abstainers, other than their non-use of alcohol, may confound the associations found between drinking and mortality risk.     

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

Aims This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all‐cause mortality. Design, participants and measurement Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES‐D) scale and an eight‐item social isolation scale. Findings The J‐shaped risk curve for all‐cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life‐time abstainer. Conclusions The relationship of alcohol consumption to 11‐year all‐cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex‐drinkers.     

Revising the preventive paradox: the Swiss case

Aims. To examine Kreitman's preventive paradox of alcohol consumption and its revisions by Stockwell and colleagues and by Skog, with regard to alcohol‐related social harm in Switzerland, and to shed light on the reporting of alcohol‐related social harm in the low‐volume drinking, non‐bingeing subpopulation. The paper compares occurrence and severity of social harm in four subgroups defined by average consumption (volume) and binge drinking. Stage‐of‐change membership was used to further distinguish low‐risk drinkers who might have changed their drinking patterns from those who had not. Design, setting, and participants. Telephone interviews were conducted with 1256 current drinkers of a probabilistic two‐stage sample of the general population of Switzerland. Moderate and hazardous mean consumption (volume) was defined by means of a quantity‐frequency instrument. Daily average consumption of 20 g was set as the cut‐off point for women, and 30 g for men. Binge drinking was defined as taking four or more drinks on an occasion for women, and five or more for men. Structural equation modelling was used to construct a severity scale of six alcohol‐related consequences: work problems, accidents and problems with the police, with friends, with a partner or with the family. Explanatory factor analysis was used to assign drinkers to motivational stages of change. Findings. Moderate drinkers in terms of volume reported more problems than hazardous drinkers, which confirms Kreitman's view. Binge drinkers reported more problems than non‐binge drinkers, confirming the view of Stockwell and colleagues. Binge drinkers were more numerous in the moderate drinking group, which constituted the majority of drinkers, in accordance with Skog's view. Binge drinkers in the moderate‐volume and hazardous‐volume drinking groups did not differ significantly as to either severity or number of problems. Approximately 40% of moderate‐volume, non‐binge drinkers who reported alcohol‐related social harm had already changed their consumption pattern, which indicated that reported harm was related to an earlier drinking pattern. Conclusions. As Skog has pointed out, the second‐order preventive paradox of binge drinking reappeared, in that most binge drinkers were found to occur in the drinker group with low average consumption. Findings also indicate that, with respect to social harm, a preventive strategy aimed at the majority of the population, but on heavy‐drinking occasions rather than on mean consumption, may be valuable.     

Alcohol consumption and mortality and hospital admissions in men from the Midspan Collaborative cohort study

Aims To investigate the relationships between alcohol consumption and mortality and morbidity risk by specific causes. Design Prospective cohort study. Setting Twenty‐seven work‐places in West and Central Scotland. Participants A total of 6000 men aged 21–64 years at screening in 1970–1973, median follow‐up 29 years. Measurements Relative rates, using Cox's proportional hazard models, by weekly reported units of alcohol consumption for all cause, coronary heart disease (CHD), stroke, respiratory, digestive, liver disease and alcohol‐related causes of mortality and for specific causes of acute hospital admissions. Findings Mortality risk was increased for men drinking 15–21 or more units per week for all causes, stroke, liver disease and alcohol‐related causes. For respiratory mortality, drinkers of 35 or more units had double the risk compared to non‐drinkers. CHD mortality showed increasing trends with consumption when adjusted for age and after full adjustment showed no clear patterns, although the 8–14 units group had a lower risk than non‐drinkers [relative rate 0.81 (0.68–0.97)]. Hospital admissions had similar patterns to mortality for stroke and liver disease. Increased risk began at 8–14 units for alcohol‐related admissions, and at 15–21 units for respiratory admissions. Non‐drinkers had higher risks of having a CHD admission than drinkers and there were decreasing trends with increasing consumption (P = 0.019). Conclusions Consumption of 15–21 units per week and over was associated with increased mortality from most causes and increased risk of hospital admissions from stroke, liver disease and respiratory diseases. Alcohol‐related admissions were raised from 8 to 14 units. Alcohol use may have been under‐reported in our study, but it was similar to other studies of the time. The apparent protective effect of alcohol with CHD admissions could be due partly to detrimental effects of heavy drinking causing sudden deaths. The associations, including that with respiratory disease, may arise from inadequate adjustment for confounding by other factors such as smoking.     

How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease?

Objective To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow‐up. Method Prospective cohort study of 5411 male civil servants aged 35–55 years at entry to the Whitehall II study in 1985–88. Alcohol consumption was reported five times over a 15‐year period. Mortality, fatal CHD, clinically verified incident non‐fatal myocardial infarction and definite angina were ascertained during follow‐up. Results We found evidence that drinkers who vary their intake during follow‐up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07–2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range. Conclusions Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time.     

Relationship Between Age and Drinking Patterns and Drinking Problems Among Japanese, Japanese-Americans, and Caucasians

Comparing alcohol consumption patterns by age and gender among Japanese in Japan and Japanese-Americans and Caucasians in the United States, this study examined the associations between age and both heavy drinking and social problems using logistic regression for each ethnic group of male current drinkers. As reported in previous studies of Caucasians, men drink more alcohol than women, older respondents are more likely than younger ones to be abstainers, and the percentages of heavier drinkers and problem drinkers are higher among the young than among older people. Although Japanese-Americans reported consuming less alcohol than Caucasians, their drinking patterns by age were similar:among both United States populations, younger respondents are at higher risk for drinking problems than older respondents, even when alcohol consumption and sociodemographic variables are controlled by logistic regression. However, this association of age and drinking patterns and drinking problems is not universal. Japanese men consumed more alcohol and had a higher proportion of heavier drinkers in the middle age groups; the association between age and drinking problems also varied in this group. In addition to aging, sociocultural factors such as drinking norms probably account for the differences in drinking behavior among different age groups. This study may stimulate further cross-cultural comparison of drinking patterns and problems.     

Alcohol-attributable injuries in admissions to a swiss emergency room--an analysis of the link between volume of drinking, drinking patterns, and preattendance drinking

BACKGROUND: An association between alcohol consumption and injury is clearly established from volume of drinking, heavy episodic drinking (HED), and consumption before injury. Little is known, however, about how their interaction raises risk of injury and what combination of factors carries the highest risk. This study explores which of 11 specified groups of drinkers (a) are at high risk and (b) contribute most to alcohol-attributable injuries. METHODS: In all, 8,736 patients, of whom 5,077 were injured, admitted to the surgical ward of the emergency department of Lausanne University Hospital between January 1, 2003, and June 30, 2004, were screened for alcohol use. Eleven groups were constructed on the basis of usual patterns of intake and preattendance drinking. Odds ratios (ORs) comparing injured and noninjured were derived, and alcohol-attributable fractions of injuries were calculated from ORs and prevalence of exposure groups. RESULTS: Risk of injury increased with volume of drinking, HED, and preattendance drinking. For both sexes, the highest risk was associated with low intake, HED, and 4 (women), 5 (men), or more drinks before injury. At the same level of preattendance drinking, high-volume drinkers were at lower risk than low-volume drinkers. In women, the group of low-risk non-HED drinkers taking fewer than 4 drinks suffered 47.5% of the alcohol-attributable injuries in contrast to only 20.4% for men. Low-volume male drinkers with HED had more alcohol-attributable injuries than that of low-volume female drinkers with HED (46.9% vs 23.2%). CONCLUSIONS: Although all groups of drinkers are at increased risk of alcohol-related injury, those who usually drink little but on occasion heavily are at particular risk. The lower risk of chronic heavy drinkers may be due to higher tolerance of alcohol. Prevention should thus target heavy-drinking occasions. Low-volume drinking women without HED and with only little preattendance drinking experienced a high proportion of injuries; such women would be well advised to drink very little or to take other special precautions in risky circumstances.     

Injury and repeated injury - what is the link with acute consumption, binge drinking and chronic heavy alcohol use?

OBJECTIVES: First, to test whether current injury is more closely related to acute intake than to usual consumption patterns, and second, to test whether repeated injury is more closely related to general consumption patterns than to acute intake. METHODS: Screening of alcohol consumption of 7,872 patients enrolling between January 1, 2003 and June 30, 2004 in an emergency department (ED) in Lausanne, Switzerland. General consumption patterns were measured as usual volume (in drinks per week) and binge drinking (5+ drinks for men; 4+ drinks for women) at least once monthly. Acute intake was measured through number of drinks in the 24-hour period prior to attending the ED. Separate logistic regression models of current injury and repeated injury on alcohol consumption patterns were estimated. RESULTS: Acute intake and binge drinking dominated the association with current injury, while general consumption patterns were predictive of repeated alcohol-related injury. CONCLUSIONS: Acute intake is associated with current injury in a dose-response relationship and with binge drinking. Because acute intake can be found among moderate volume drinkers as well as among chronic heavy drinkers, for current injury usual volume adds little predictive value over the effects of acute intake. Repeated injuries occur more often among chronic heavy drinkers, and thus general consumption patterns are more closely associated with injury "recidivism" than with acute intake. A screening question assessing prior injury may be a useful tool in the ED for distinguishing between chronic heavy drinkers and usually moderate drinkers with heavy drinking episodes, and thus prove helpful when creating preventive efforts tailored to different types of drinker.     

Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study

Aims To investigate the relationship between three measures of alcohol consumption obtained simultaneously in a large cohort and the validated risk of coronary heart disease and all‐cause mortality during follow‐up. Design Prospective cohort study with median follow‐up of 11 years. Setting The Whitehall II Cohort Study: London‐based civil service. Participants A total of 10 308 (33% female) civil servants aged 35–55 years at baseline (1985–88). Measurements Self‐reported volume of alcohol consumed during past week, frequency of drinking over past year, usual amount consumed per drinking session. Main outcome measures Coronary heart disease and all‐cause mortality until 1999. Findings A U‐shaped relationship was found between volume of alcohol consumed per week and outcome. Compared to those who drank moderately (10–80 g alcohol per week), non‐drinkers and those drinking more than 248 g per week had approximately a twofold increased risk of mortality. The optimal frequency of drinking was between once or twice a week and daily, after adjustment for average volume consumed per week. Those drinking twice a day or more had an increased risk of mortality (male hazard ratio 2.44 95% CI 1.31–4.52) compared to those drinking once or twice a week. Drinking only once a month or only on special occasions had a 50% increased risk of mortality. The usual amount consumed per drinking session was not indicative of increased health risk in this cohort. Conclusions Epidemiological studies should collect information on frequency of drinking in addition to average volume consumed in order to inform sensible drinking advice.     

Alcohol and atherosclerosis: Recent insights

Light to moderate alcohol intake is known to have cardioprotective properties; however, the magnitude of protection depends on other factors and may be confined to some subsets of the population. This review focuses on factors that modify the relationship between alcohol and coronary heart disease (CHD). The cardio-protective effect of alcohol seems to be larger among middle-aged and elderly adults than among young adults, who do not have a net beneficial effect of a light to moderate alcohol intake in terms of reduced all-cause mortality. The levels of alcohol at which the risk of CHD is lowest and the levels of alcohol at which the risk of CHD exceeds the risk among abstainers are lower for women than for men. The pattern of drinking seems important for the apparent cardioprotective effect of alcohol, and the risk of CHD is generally lower for steady versus binge drinking. Finally, there is some evidence that wine may have more beneficial effects than beer and distilled spirits; however, these results are still controversial and may be confounded by personal characteristics and other lifestyle factors such as diet. The inverse association between alcohol intake and CHD is influenced by age, gender, drinking pattern, and possibly by type of alcohol.     

Alcohol and Self-Rated Health in a Mediterranean Country: The Role of Average Volume, Drinking Pattern, and Alcohol Dependence

Background: The association between average alcohol consumption and self‐rated ill‐health is “J‐shaped” in Scandinavian and Anglo‐Saxon countries, but it has shown an inverse linear relationship in the few studies conducted in Mediterranean countries, based on average volume solely. Objective: To examine the relationship between alcohol and self‐rated health in the general population of a Mediterranean country, by simultaneously taking into account average volume, drinking pattern, and alcohol abuse. Methods: From 2000 to 2005, we conducted telephone interviews on 12,037 persons, representative of the population aged 18 to 64 years in Madrid, Spain. The drinking pattern encompassed binge drinking, beverage preference, and drinking at mealtimes. Alcohol abuse was estimated by the CAGE test. The association between each alcohol‐related variable and self‐rated suboptimal (fair, poor, or very poor) health was estimated from logistic regression, with adjustment for the remaining alcohol‐related variables and other potential confounders. Results: In comparison with never‐drinkers, suboptimal health was less frequent among occasional drinkers [odds ratio (OR) 0.72; 95% confidence interval (CI): 0.61 to 0.86], average moderate drinkers (OR 0.57; 95% CI: 0.48 to 0.69), and excessive drinkers (OR 0.51; 95% CI: 0.36 to 0.72), but more frequent among former drinkers with ≥1 year of abstinence (OR 1.30; 95% CI: 1.03 to 1.64). Frequency of suboptimal health was likewise higher in subjects with ≥3 episodes of binge drinking (OR 1.55; 95% CI: 1.12 to 2.14) or alcohol abuse (OR 1.47; 95% CI: 1.22 to 1.76). No differences were observed in suboptimal health according to beverage preference or drinking at mealtimes. Results in each gender were similar to those for total study participants. Conclusions: Occasional, moderate, and excessive consumption of alcohol are associated with better self‐rated health, even after adjustment for drinking pattern and alcohol abuse. In contrast, former‐drinking, frequent binge drinking, and alcohol abuse are all associated with suboptimal self‐rated health.     

Alcohol drinking pattern and non-fatal myocardial infarction in women

AIMS: Evidence continues to emerge indicating the pattern of alcohol consumption has important implications for cardiovascular disease (CVD) risk, although the majority of studies have focused on men. The aim of the study is to examine the association between alcohol volume and various drinking patterns and non-fatal myocardial infarction (MI) in women aged 35-69 years. DESIGN AND SETTING: Population-based case-control study, 1996-2001. PARTICIPANTS: Incident MI cases (n = 320) recruited from Western NY hospitals, controls (n = 1565) identified from motor vehicle rolls and Health Care Financing Administration (HCFA) files. MEASUREMENTS: Incident MI, volume and drinking patterns for the 12-24 months prior to interview (controls) or MI (cases) were assessed in detail. FINDINGS: Of cases and controls, 13% were life-time abstainers; current drinkers averaged 2.3 +/- 2.2 drinks/drinking day. Compared to life-time abstainers, current drinkers tended to have a reduced likelihood of MI [odds ratio (OR), 0.67; 95% confidence interval (CI), 0.43-1.03]. Volume, drinks/drinking day and frequency were associated inversely with MI risk (P trends < 0.001). Wine drinkers (OR, 0.56; 95% CI, 0.33-0.96) and consumers of mixed beverage types (OR, 0.56, 0.31-1.01) had lower odds of MI compared to abstainers. Among current drinkers, for volume and most patterns, similar but somewhat weaker associations were noted than when abstainers were the reference. In contrast, frequency of intoxication at least once/month or more was associated with a strong increased risk compared to abstention (OR, 2.90; 95% CI 1.01-8.29) or in current drinkers, never drinking to this extent (OR, 6.22; 95% CI 2.07-18.69). CONCLUSION: In this population of light to moderate drinkers, alcohol consumption in general was associated with decreased MI risk in women; however, episodic intoxication was related to a substantial increase in risk.     

Alcohol drinking pattern and subjective health in a population-based study

AIMS: Some patterns of alcohol consumption (e.g. binge drinking, drinking outside of meals) have been associated with detrimental effects on health outcomes. Subjective health provides a global assessment of health status and is a strong predictor of total mortality; however, little is known about its relationship with alcohol drinking pattern. The association between several drinking patterns (i.e. drinking intensity and frequency, frequency of intoxication, drinking outside of meals, and beverage type) and subjective health was examined in a random sample of 3586 women and men. DESIGN: A population-based cross-sectional study. METHODS: Subjective health was assessed using the physical and mental health component summaries of the Short Form-36 health survey questionnaire. Alcohol consumption refers to the 30 days before the interview. Analysis of covariance compared gender-specific mean scores across alcohol drinking patterns. FINDINGS: Overall, non-current drinkers reported poorer physical and mental health than life-time abstainers and current drinkers, while no consistent differences were found between life-time abstainers and current drinkers. In female current drinkers, daily drinking, beer and mixed beverage consumption were associated with better mental health. In male current drinkers, moderate alcohol consumption (2-2.9 drinks per day), wine and mixed beverage consumption were associated with better physical health. Intoxication and liquor consumption were associated with poorer mental health in women and poorer physical health in men. No consistent associations were found for drinking outside meals. CONCLUSIONS: Aspects of drinking pattern may affect subjective health differentially in women and men. Overall, intoxication and liquor drinking are associated with poorer self-perceived health status than regular, moderate consumption of other alcoholic beverages.     

Alcohol consumption and cardiovascular mortality accounting for possible misclassification of intake: 11-year follow-up of the Melbourne Collaborative Cohort Study

AIMS: To investigate the relationship between usual daily alcohol intake, beverage type and drinking frequency on cardiovascular (CVD) and coronary heart disease (CHD) mortality, accounting for systematic misclassification of intake. DESIGN: Prospective cohort study with mean follow-up of 11.4 years. Setting The Melbourne Collaborative Cohort Study, Australia. PARTICIPANTS: A total of 38 200 volunteers (23 044 women) aged 40-69 years at baseline (1990-1994). MEASUREMENTS: Self-reported alcohol intake using beverage-specific quantity-frequency questions (usual intake) and drinking diary for previous week. FINDINGS: Compared with life-time abstention, usual daily alcohol intake was associated with lower CVD and CHD mortality risk for women but not men. For women, the hazard ratio [HR (95% CI)] for CVD for those drinking > 20 g/day alcohol was 0.43 (0.19-0.95; P trend = 0.18), and for CHD, 0.19 (0.05-0.82; P trend = 0.24). Male former drinkers had over twice the mortality risk for CVD [HR = 2.58 (1.51-4.41)] and CHD [HR = 2.91 (1.59-5.33)]. Wine was the only beverage associated inversely with mortality for women. Compared with drinkers who consumed no alcohol in the week before baseline, drinking frequency was associated inversely with CVD and CHD mortality risk for men but not women. HR for men drinking 6-7 days/week was 0.49 (0.29-0.81; P trend = 0.02) for CVD, and 0.49 (0.26-0.92: P trend = 0.23) for CHD. CONCLUSIONS: Usual daily alcohol intake was associated with reduced CVD and CHD mortality for women but not men. This benefit appeared to be mainly from wine, although comparison of beverages was not possible. Drinking frequency was associated inversely with CVD and CHD death for men but not women.     

Hazardous drinking is associated with a lower risk of coronary heart disease: results from a national representative sample

This analysis assesses the 12-month prevalence of coronary heart disease (CHD) in individuals according to their category of alcohol use. The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions study (the NESARC, n = 43,093) identified 16,147 abstinent individuals, 15,884 moderate consumers, 9,578 hazardous drinkers-defined as exceeding sex-specific weekly limits established by the World Health Organization, and 1,484 alcohol-dependent subjects. Diagnoses were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Both moderate and hazardous drinking were associated with decreased odds of CHD when compared with abstinence, whereas odds of CHD were not significantly different between alcohol-dependent and abstinent participants. A moderate or even a hazardous consumption of alcohol is associated with a decreased likelihood of CHD after controlling for sociodemographic, psychiatric, and addictive risk factors. Our study shows that alcohol may have cardioprotective effects not only in moderate drinkers, but also in individuals with patterns of use traditionally considered as hazardous.     

In vino veritas: alcohol and heart disease

Numerous epidemiological studies, numbering nearly 100, have documented an inverse association between alcohol consumption and vascular risk. The preponderance of evidence supports an independent beneficial effect of mild-to-moderate alcoholic beverage consumption on risk of coronary heart disease (CHD). However, it is important to remember that observational data cannot prove causation; unmeasured or incompletely controlled confounding factors cannot be excluded. That said, most authorities now attribute a causal role to the relationship: moderate alcohol consumption reduces the risk of CHD, and current research centers on the mechanistic underpinnings and whether patterns of drinking are important. Here, I review the association between alcohol use and CHD risk, explore putative mechanisms, and make recommendations.