alcohol and coronary heart disease

Last edited 09/2018

There has been evidence that moderate consumption of alcohol is inversely related with coronary disease, but its association with mortality is controversial (1)

• note though that a meta-analysis of 34 prospective studies revealed (1):
  • low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) were inversely associated with total mortality in both men and women
    • the study authors commented that their findings, while confirming the hazards of excess drinking, indicated potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival

A more recent study of the alcohol consumption over nearly 600k alcohol drinkers found (2):

Results

• in the 599912 current drinkers included in the analysis
  • there were recorded 40310 deaths and 39018 incident cardiovascular disease events during 5.4 million person-years of follow-up
  • for all-cause mortality
    • recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week
  • for cardiovascular disease
  • 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 >0 to <=100 g (mean 56 g) per week, those who reported drinking

>100 to <=200 g per week had lower life expectancy at age 40 years of approximately 6 months,

>200 to <=350 g per week had lower life expectancy at age 40 years of approximately of 1-2 years,

>350 g per week had lower life expectancy at age 40 years of approximately 4-5 years

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

Notes:

• 100g of alcohol per week is equivalent to approximately 12.5 units of alcohol per week

In guidance concerning alcohol consumption and health (3):

The Chief Medical Officers' guideline for both men and women is that:

• You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level
  
  
• If you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more. If you have one or two heavy drinking sessions, you increase your risks of death from long term illnesses and from accidents and injuries
  
  
• The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis
  
  
• If you wish to cut down the amount you're drinking, a good way to help achieve this is to have several drink-free days each week

Reference:

• (1) Di Castelnuovo A et al. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006 Dec 11-25;166(22):2437-45.
• (2) Wood AM et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599,912 current drinkers in 83 prospective studies.Lancet. 2018 Apr 14;391(10129):1513-1523
• (3) DOH (January 2016). How to keep health risks from drinking alcohol to a low level: public consultation on proposed new guidelines.