08059nas a2201585 4500008004100000022001400041245015200055210006900207260001500276300001400291490000800305520349800313100002003811700002103831700002503852700001903877700002403896700001903920700001703939700001803956700002203974700002103996700001704017700001904034700001904053700002004072700002104092700002904113700001904142700002104161700001904182700002004201700002804221700001604249700002104265700001904286700002104305700002104326700002004347700002104367700002204388700001804410700001804428700002104446700002104467700002004488700003504508700001904543700002304562700002204585700002504607700002204632700002204654700001804676700002004694700001904714700002404733700002304757700002004780700002304800700002604823700002404849700002104873700002404894700002304918700001804941700002004959700001904979700002104998700001905019700002205038700002005060700001605080700002105096700002605117700002105143700002005164700001905184700003105203700001905234700002405253700001705277700002005294700002105314700001805335700002205353700002205375700002005397700002005417700003305437700002205470700002605492700001805518700002605536700003005562700002405592700001905616700001705635700002005652700001805672700002405690700001805714700002005732700002605752700001805778700002205796700002505818700002005843700002205863700002105885700002005906700002305926700002205949700002105971700002005992700002406012700002106036700001806057700002306075700002306098700001406121700001906135700001806154700002306172700002006195700001906215700002406234700001806258700001706276700001706293700003006310700001706340710008006357856003606437 2018 eng d a1474-547X00aRisk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies.0 aRisk thresholds for alcohol consumption combined analysis of ind c2018 04 14 a1513-15230 v3913 a
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 >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >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.
FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
1 aWood, Angela, M1 aKaptoge, Stephen1 aButterworth, Adam, S1 aWilleit, Peter1 aWarnakula, Samantha1 aBolton, Thomas1 aPaige, Ellie1 aPaul, Dirk, S1 aSweeting, Michael1 aBurgess, Stephen1 aBell, Steven1 aAstle, William1 aStevens, David1 aKoulman, Albert1 aSelmer, Randi, M1 aVerschuren, W, M Monique1 aSato, Shinichi1 aNjølstad, Inger1 aWoodward, Mark1 aSalomaa, Veikko1 aNordestgaard, Børge, G1 aYeap, Bu, B1 aFletcher, Astrid1 aMelander, Olle1 aKuller, Lewis, H1 aBalkau, Beverley1 aMarmot, Michael1 aKoenig, Wolfgang1 aCasiglia, Edoardo1 aCooper, Cyrus1 aArndt, Volker1 aFranco, Oscar, H1 aWennberg, Patrik1 aGallacher, John1 ade la Cámara, Agustin, Gómez1 aVölzke, Henry1 aDahm, Christina, C1 aDale, Caroline, E1 aBergmann, Manuela, M1 aCrespo, Carlos, J1 aSchouw, Yvonne, T1 aKaaks, Rudolf1 aSimons, Leon, A1 aLagiou, Pagona1 aSchoufour, Josje, D1 aBoer, Jolanda, M A1 aKey, Timothy, J1 aRodriguez, Beatriz1 aMoreno-Iribas, Conchi1 aDavidson, Karina, W1 aTaylor, James, O1 aSacerdote, Carlotta1 aWallace, Robert, B1 aQuiros, Ramon1 aTumino, Rosario1 aBlazer, Dan, G1 aLinneberg, Allan1 aDaimon, Makoto1 aPanico, Salvatore1 aHoward, Barbara1 aSkeie, Guri1 aStrandberg, Timo1 aWeiderpass, Elisabete1 aNietert, Paul, J1 aPsaty, Bruce, M1 aKromhout, Daan1 aSalamanca-Fernandez, Elena1 aKiechl, Stefan1 aKrumholz, Harlan, M1 aGrioni, Sara1 aPalli, Domenico1 aHuerta, José, M1 aPrice, Jackie1 aSundström, Johan1 aArriola, Larraitz1 aArima, Hisatomi1 aTravis, Ruth, C1 aPanagiotakos, Demosthenes, B1 aKarakatsani, Anna1 aTrichopoulou, Antonia1 aKühn, Tilman1 aGrobbee, Diederick, E1 aBarrett-Connor, Elizabeth1 avan Schoor, Natasja1 aBoeing, Heiner1 aOvervad, Kim1 aKauhanen, Jussi1 aWareham, Nick1 aLangenberg, Claudia1 aForouhi, Nita1 aWennberg, Maria1 aDesprés, Jean-Pierre1 aCushman, Mary1 aCooper, Jackie, A1 aRodriguez, Carlos, J1 aSakurai, Masaru1 aShaw, Jonathan, E1 aKnuiman, Matthew1 aVoortman, Trudy1 aMeisinger, Christa1 aTjønneland, Anne1 aBrenner, Hermann1 aPalmieri, Luigi1 aDallongeville, Jean1 aBrunner, Eric, J1 aAssmann, Gerd1 aTrevisan, Maurizio1 aGillum, Richard, F1 aFord, Ian1 aSattar, Naveed1 aLazo, Mariana1 aThompson, Simon, G1 aFerrari, Pietro1 aLeon, David, A1 aSmith, George Davey1 aPeto, Richard1 aJackson, Rod1 aBanks, Emily1 aDi Angelantonio, Emanuele1 aDanesh, John1 aEmerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group uhttps://chs-nhlbi.org/node/7664