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Moderate Alcohol Consumption and Cardiovascular Outcomes

Bell et al report a “big data” analysis of the relationship between alcohol consumption and cardiovascular outcomes. The editorial is available here.

Abstract

Objectives

To investigate the association between alcohol
consumption and cardiovascular disease at higher
resolution by examining the initial lifetime
presentation of 12 cardiac, cerebrovascular,
abdominal, or peripheral vascular diseases among five
categories of consumption.

Design

Population based cohort study of linked electronic
health records covering primary care, hospital
admissions, and mortality in 1997-2010 (median
follow-up six years).

Setting

CALIBER (ClinicAl research using LInked Bespoke
studies and Electronic health Records).
Participants
1 937 360 adults (51% women), aged ≥30 who were free
from cardiovascular disease at baseline.

Main outcome measures

12 common symptomatic manifestations of
cardiovascular disease, including chronic stable
angina, unstable angina, acute myocardial infarction,
unheralded coronary heart disease death, heart
failure, sudden coronary death/cardiac arrest,
transient ischaemic attack, ischaemic stroke,
intracerebral and subarachnoid haemorrhage,
peripheral arterial disease, and abdominal aortic
aneurysm.

Results

114 859 individuals received an incident cardiovascular
diagnosis during follow-up. Non-drinking was
associated with an increased risk of unstable angina
(hazard ratio 1.33, 95% confidence interval 1.21 to
1.45), myocardial infarction (1.32, 1.24 to1.41),
unheralded coronary death (1.56, 1.38 to 1.76), heart
failure (1.24, 1.11 to 1.38), ischaemic stroke (1.12, 1.01 to
1.24), peripheral arterial disease (1.22, 1.13 to 1.32),
and abdominal aortic aneurysm (1.32, 1.17 to 1.49)
compared with moderate drinking (consumption
within contemporaneous UK weekly/daily guidelines
of 21/3 and 14/2 units for men and women,
respectively). Heavy drinking (exceeding guidelines)
conferred an increased risk of presenting with
unheralded coronary death (1.21, 1.08 to 1.35), heart
failure (1.22, 1.08 to 1.37), cardiac arrest (1.50, 1.26 to
1.77), transient ischaemic attack (1.11, 1.02 to 1.37),
ischaemic stroke (1.33, 1.09 to 1.63), intracerebral
haemorrhage (1.37, 1.16 to 1.62), and peripheral arterial
disease (1.35; 1.23 to 1.48), but a lower risk of
myocardial infarction (0.88, 0.79 to 1.00) or stable
angina (0.93, 0.86 to 1.00).

Conclusions

Heterogeneous associations exist between level of
alcohol consumption and the initial presentation of
cardiovascular diseases. This has implications for
counselling patients, public health communication,
and clinical research, suggesting a more nuanced
approach to the role of alcohol in prevention of
cardiovascular disease is necessary.

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