Alcohol Consumption and Cardiovascular Disease Outcomes
Alcohol Consumption and Cardiovascular Disease Outcomes
Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes.
Design Systematic review and meta-analysis.
Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings.
Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke.
Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis.
Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).
Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.
Possible cardioprotective effects of alcohol consumption seen in observational studies continue to be hotly debated in the medical literature and popular media. In the absence of clinical trials, clinicians must interpret these data when answering patients’ questions about taking alcohol to reduce their risk of cardiovascular disease. Systematic reviews and meta-analyses have addressed the association of alcohol consumption with cardiovascular disease outcomes but have not uniformly addressed associations between alcohol use and mortality from cardiovascular disease, as well as the incidence and mortality from coronary heart disease and stroke. Additionally, further studies have been published since 2006, when the most recent reviews appeared. The continuing debate on this subject warrants an in depth reassessment of the evidence.
In this paper, we synthesise results from longitudinal cohort studies comparing alcohol drinkers with non-drinkers for the outcomes of overall mortality from cardiovascular disease, incident coronary heart disease, mortality from coronary heart disease, incident stroke, and mortality from stroke. Because of the many biological effects of alcohol consumption, we also examine the association of alcohol with mortality from all causes when this is reported in studies. We conducted meta-analyses for each of these outcomes and a sensitivity analysis with lifetime abstainers as the reference category to account for the heterogeneity within the reference group of non-drinkers. We also examined the effect of confounding on the strength of observed associations. In our companion paper, we link these cardiovascular outcomes with experimental trials of alcohol consumption on candidate causal molecular markers.
Abstract
Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes.
Design Systematic review and meta-analysis.
Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings.
Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke.
Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis.
Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).
Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.
Introduction
Possible cardioprotective effects of alcohol consumption seen in observational studies continue to be hotly debated in the medical literature and popular media. In the absence of clinical trials, clinicians must interpret these data when answering patients’ questions about taking alcohol to reduce their risk of cardiovascular disease. Systematic reviews and meta-analyses have addressed the association of alcohol consumption with cardiovascular disease outcomes but have not uniformly addressed associations between alcohol use and mortality from cardiovascular disease, as well as the incidence and mortality from coronary heart disease and stroke. Additionally, further studies have been published since 2006, when the most recent reviews appeared. The continuing debate on this subject warrants an in depth reassessment of the evidence.
In this paper, we synthesise results from longitudinal cohort studies comparing alcohol drinkers with non-drinkers for the outcomes of overall mortality from cardiovascular disease, incident coronary heart disease, mortality from coronary heart disease, incident stroke, and mortality from stroke. Because of the many biological effects of alcohol consumption, we also examine the association of alcohol with mortality from all causes when this is reported in studies. We conducted meta-analyses for each of these outcomes and a sensitivity analysis with lifetime abstainers as the reference category to account for the heterogeneity within the reference group of non-drinkers. We also examined the effect of confounding on the strength of observed associations. In our companion paper, we link these cardiovascular outcomes with experimental trials of alcohol consumption on candidate causal molecular markers.
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