5 Quartile 4 (≥14) 124,360 6860 183 17.7 Journal of Aging Research Person-years No. No. of Deaths Death ratea Table 3: Hazard ratios of CVD mortality by alcohol consumption level in men, Aerobics Center for Longitudinal Study (ACLS), 1974–2002. Nondrinkers (0) 86,872 4742 128 17.0 Alcohol consumption (drinks/week) Quartile 1 (1–3) Quartile 2 (4–6) Quartile 3 (7–13) 91,529 98,303 103,625 6663 6049 6735 70 101 106 11.6 13.1 12.9 Basic modelb 1.00 (referent) 0.71 (0.53–0.95) 0.75 (0.58–0.98) 0.83 (0.64–1.08) 1.00 (0.80–1.26) Basic model plus Blood pressure factorsc 1.00 (referent) 0.70 (0.53–0.94) 0.73 (0.56–0.95) 0.84 (0.64–1.09) 0.94 (0.75–1.18) Fasting glucose factorsd 1.00 (referent) 0.68 (0.51–0.91) 0.75 (0.58–0.98) 0.82 (0.63–1.07) 0.98 (0.78–1.24) Lipid factorse 1.00 (referent) 0.71 (0.53–0.95) 0.73 (0.56–0.96) 0.80 (0.62–1.04) 0.95 (0.75–1.19) All intermediate factorscde 1.00 (referent) 0.68 (0.51–0.91) 0.71 (0.55–0.93) 0.81 (0.62–1.05) 0.88 (0.69–1.11) a Death rate per 10,000 person-years adjusted for age (in years). bAdjusted for age (in years), year of examination, BMI (kg/m2), smoking (current smoker or not), family history of CVD (yes or no), and maximal treadmill time (min). cSystolic blood pressure and reported hypertension (yes or no). dFasting glucose and reported diabetes (yes or no). eTotal cholesterol and triglyceride. Table 4: Hazard ratios of all-cause mortality stratiﬁed by risk factorsa, Aerobics Center for Longitudinal Study (ACLS), 1974–2002. Nondrinkers (0) Alcohol consumption (drinks/week) Quartile 1 (1–3) Quartile 2 (4–6) Quartile 3 (7–13) Quartile 4 (≥14) Age Age <60 (n = 30, 263) 1.00 (referent) 0.80 (0.66–0.96) 0.92 (0.78–1.09) 1.02 (0.86–1.20) 1.08 (0.93–1.26) Age ≥60 (n = 1, 374) 1.00 (referent) 0.86 (0.59–1.25) 0.85 (0.59–1.23) 0.75 (0.52–1.08) 1.04 (0.76–1.44) BMI BMI <25 (n = 12, 037) 1.00 (referent) 0.85 (0.65–1.11) 1.03 (0.80–1.32) 0.95 (0.74–1.22) 0.97 (0.77–1.23) BMI ≥25 (n = 19, 600) 1.00 (referent) 0.86 (0.70–1.06) 0.90 (0.75–1.09) 0.96 (0.79–1.16) 1.12 (0.95–1.33) Health statusb Healthy (n = 15, 989) 1.00 (referent) 0.91 (0.69–1.20) 0.92 (0.71–1.19) 1.10 (0.86–1.42) 1.11 (0.87–1.41) Unhealthy (n = 15, 648) 1.00 (referent) 0.82 (0.67–1.01) 0.97 (0.81–1.17) 0.88 (0.73–1.07) 1.05 (0.89–1.24) Fitness level Unﬁt (least ﬁt 20%) (n = 5, 238) 1.00 (referent) 0.91 (0.67–1.22) 1.02 (0.79–1.32) 1.10 (0.83–1.44) 1.17 (0.92–1.48) Fit (most ﬁt 80%) (n = 26, 399) 1.00 (referent) 0.84 (0.69–1.03) 0.91 (0.76–1.10) 0.87 (0.73–1.05) 1.01 (0.85–1.19) a Adjusted for year of examination, smoking (current smoker or not), family history of CVD (yes or no), and each other factor in the table. bDeﬁned as presence or absence of one or more of following diseases: hypertension, diabetes, or hyperlipidemia. Various authors have used diﬀerent deﬁnitions of drinks ranging from 8 grams of alcohol per drink [10] to 22.8 grams [6]. Therefore, we did not attempt to impose grams of alcohol conversion factors on self-reported drinks per week. There is additional complexity when looking at the myriad of cardiovascular outcomes. Previous studies have used various outcomes including CVD mortality, cardiac mortality, CHD, and myocardial infarction. For example, Beulens et al. [37] found a reduction in risk of myocardial infarction, but not in all-cause or CVD mortality. Due to such variation, it is challenging to establish widespread recommendations for a safe or protective amount of alcohol consumption as related to CV health. While a decrease in risk of all-cause mortality with alcohol consumption was not found in this sample, there was not a signiﬁcantly increased risk with the highest amounts of self-reported alcohol consumption. Klatsky [12] deﬁned heavy drinking as greater than 3 drinks per day, which is consistent with the mean 24 drinks per week found in the highest quartile of alcohol consumption in this study. While our sample did not show a higher risk of either all-cause or CVD mortality with the highest alcohol consumption, there are other concerns in recommending drinking alcohol including potential alcohol abuse. Rehm et al. [44] estimated 12.1% of disability-adjusted life years for men in the US were attributed to alcohol-related causes with an estimated cost of $235 billion dollars. Of problem drinkers, 82% report drinking the moderate amount recommended to protect against CVD [17]. Alcohol may be harmful in many ways, even in small amounts (e.g., as a cocarcinogen with tobacco smoke) [45].