Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies
Creators: name: Wood, Angela M.
name: Kaptoge, Stephen
name: Butterworth, Adam S.
name: Willeit, Peter
name: Warnakula, Samantha
name: Bolton, Thomas
name: Paige, Ellie
name: Paul, Dirk S.
name: Sweeting, Michael
name: Burgess, Stephen
name: Bell, Steven
name: Astle, William
name: Stevens, David
name: Koulman, Albert
name: Selmer, Randi
name: Verschuren, W. M. Monique
name: Sato, Shinichi
name: Njølstad, Inger
name: Woodward, Mark
name: Salomaa, Veikko
name: Nordestgaard, Børge G.
name: Yeap, Bu B.
name: Fletcher, Astrid
name: Melander, Olle
name: Kuller, Lewis H.
name: Balkau, Beverley
name: Marmot, Michael
name: Koenig, Wolfgang
name: Casiglia, Edoardo
name: Cooper, Cyrus
name: Arndt, Volker
name: Franco, Oscar H.
name: Wennberg, Patrik
name: Gallacher, John
name: Gómez De La Cámara, Agustín
name: Völzke, Henry
name: Dahm, Christina C.
name: Dale, Caroline E.
name: Bergmann, Manuela M.
name: Crespo, Carlos J.
name: Van Der Schouw, Yvonne T.
name: Kaaks, Rudolf
name: Simons, Leon A.
name: Lagiou, Pagona
name: Schoufour, Josje D.
name: Boer, Jolanda M. A.
name: Key, Timothy J.
name: Rodriguez, Beatriz
name: Moreno-Iribas, Conchi
name: Davidson, Karina W.
name: Taylor, James O.
name: Sacerdote, Carlotta
name: Wallace, Robert B.
name: Quiros, J. Ramon
name: Tumino, Rosario
name: Blazer II, Dan G.
name: Linneberg, Allan
name: Daimon, Makoto
name: Panico, Salvatore
name: Howard, Barbara
name: Skeie, Guri
name: Strandberg, Timo
name: Weiderpass, Elisabete
name: Nietert, Paul J.
name: Psaty, Bruce M.
name: Kromhout, Daan
name: Salamanca-Fernandez, Elena
name: Kiechl, Stefan
name: Krumholz, Harlan M.
name: Grioni, Sara
name: Palli, Domenico
name: Huerta, José M.
name: Price, Jackie F.
name: Sundström, Johan
name: Arriola, Larraitz
name: Arima, Hisatomi
name: Travis, Ruth C.
name: Panagiotakos, Demosthenes B.
name: Karakatsani, Anna
name: Trichopoulou, Antonia
name: Kühn, Tilman
name: Grobbee, Diederick E.
name: Barrett-Connor, Elizabeth
name: Van Schoor, Natasja
name: Boeing, Heiner
name: Overvad, Kim
name: Kauhanen, Jussi
name: Wareham, Nicholas J.
name: Langenberg, Claudia
name: Forouhi, Nita
name: Wennberg, Maria
name: Després, Jean-Pierre
name: Cushman, Mary
name: Cooper, Jackie A,
name: Rodriguez, Carlos J.
name: Sakurai, Masaru
name: Shaw, Jonathan E.
name: Knuiman, Matthew W.
name: Voortman, Trudy
name: Meisinger, Christa
name: Tjønneland, Anne
name: Brenner, Hermann
name: Palmieri, Luigi
name: Dallongeville, Jean
name: Brunner, Eric J.
name: Assmann, Gerd
name: Trevisan, Maurizio
name: Gillum, Richard F.
name: Ford, Ian
name: Sattar, Naveed
name: Lazo, Mariana
name: Thompson, Simon G.
name: Ferrari, Pietro
name: Leon, David A.
name: Davey-Smith, George
name: Peto, Richard
name: Jackson, Rod
name: Banks, Emily
name: Di Angelantonio, Emanuele
name: Danesh, John
name: Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group
Publisher: name: Columbia University
Year: 2018
Subjects: Drinking of alcoholic beverages
Cardiovascular system--Diseases
Mortality
Diseases--Risk factors

description: BACKGROUND: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. METHODS: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies. FINDINGS: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking &gt;0-≤100 g per week, those who reported drinking &gt;100-≤200 g per week, &gt;200-≤350 g per week, or &gt;350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. INTERPRETATION: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.