Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1513-1523 |
| Number of pages | 11 |
| Journal | The Lancet |
| Volume | 391 |
| Issue number | 10129 |
| DOIs | |
| Publication status | Published - 14 Apr 2018 |
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Risk thresholds for alcohol consumption : combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. / Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group.
In: The Lancet, Vol. 391, No. 10129, 14.04.2018, p. 1513-1523.Research output: Contribution to journal › Article
TY - JOUR
T1 - Risk thresholds for alcohol consumption
T2 - combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies
AU - Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group
AU - Wood, Angela M.
AU - Kaptoge, Stephen
AU - Butterworth, Adam
AU - Willeit, Peter
AU - Warnakula, Samantha
AU - Bolton, Thomas
AU - Paige, Ellie
AU - Paul, Dirk S.
AU - Sweeting, Michael
AU - Burgess, Stephen
AU - Bell, Steven
AU - Astle, William
AU - Stevens, David
AU - Koulman, Albert
AU - Selmer, Randi M.
AU - Verschuren, Monique
AU - Sato, Shinichi
AU - Njølstad, Inger
AU - Woodward, Mark
AU - Salomaa, Veikko
AU - Nordestgaard, Børge G.
AU - Yeap, Bu B.
AU - Fletcher, Astrid
AU - Melander, Olle
AU - Kuller, Lewis H.
AU - Balkau, Beverley
AU - Marmot, Michael
AU - Koenig, Wolfgang
AU - Casiglia, Edoardo
AU - Cooper, Cyrus
AU - Arndt, Volker
AU - Franco, Oscar H.
AU - Wennberg, Patrik
AU - Gallacher, John
AU - de la Cámara, Agustín Gómez
AU - Völzke, Henry
AU - Dahm, Christina C.
AU - Dale, Caroline E.
AU - Bergmann, Manuela
AU - Crespo, Carlos
AU - van der Schouw, Yvonne T.
AU - Kaaks, Rudolf
AU - Simons, Leon A.
AU - Lagiou, Pagona
AU - Schoufour, Josje D.
AU - Boer, Jolanda M.A.
AU - Key, Timothy J.
AU - Rodriguez, Beatriz
AU - Moreno-Iribas, Conchi
AU - Davidson, Karina W.
AU - Taylor, James O.
AU - Sacerdote, Carlotta
AU - Wallace, Robert B.
AU - Quiros, J. Ramon
AU - Tumino, Rosario
AU - Blazer, Dan G.
AU - Linneberg, Allan
AU - Daimon, Makoto
AU - Panico, Salvatore
AU - Howard, Barbara
AU - Skeie, Guri
AU - Strandberg, Timo
AU - Weiderpass, Elisabete
AU - Psaty, Bruce M.
AU - Kromhout, Daan
AU - Salamanca-Fernandez, Elena
AU - Kiechl, Stefan
AU - Krumholz, Harlan M.
AU - Grioni, Sara
AU - Palli, Domenico
AU - Huerta, José M.
AU - Price, Jackie
AU - Sundström, Johan
AU - Arriola, Larraitz
AU - Arima, Hisatomi
AU - Travis, Ruth C.
AU - Panagiotakos, Demosthenes B.
AU - Karakatsani, Anna
AU - Trichopoulou, Antonia
AU - Kühn, Tilman
AU - Grobbee, Diederick E.
AU - Barrett-Connor, Elizabeth
AU - van Schoor, Natasja
AU - Boeing, Heiner
AU - Overvad, Kim
AU - Kauhanen, Jussi
AU - Wareham, Nick
AU - Langenberg, Claudia
AU - Forouhi, Nita
AU - Wennberg, Maria
AU - Després, Jean Pierre
AU - Cushman, Mary
AU - Cooper, Jackie A.
AU - Rodriguez, Carlos J.
AU - Sakurai, Masaru
AU - Shaw, Jonathan E.
AU - Knuiman, Matthew
AU - Voortman, Trudy
AU - Meisinger, Christa
AU - Tjønneland, Anne
AU - Brenner, Hermann
AU - Palmieri, Luigi
AU - Dallongeville, Jean
AU - Brunner, Eric J.
AU - Assmann, Gerd
AU - Trevisan, Maurizio
AU - Gillum, Richard F.
AU - Sattar, Naveed
AU - Lazo, Mariana
AU - Thompson, Simon
AU - Ferrari, Pietro
AU - Leon, David A.
AU - Smith, George Davey
AU - Peto, Richard
AU - Jackson, Rod
AU - Banks, Emily
AU - Di Angelantonio, Emanuele
AU - Danesh, John
AU - Butterworth, Adam
AU - Verschuren, Monique
AU - Veikko, Salomaa
AU - Gómez de la Cámara, Agustín
AU - Bergmann, Manuela
AU - Crespo, Carlos
AU - Rimm, Eric B.
AU - Strandberg, Timo
AU - Nietert, Paul J.
AU - Dallongeville, Jean Pierre
AU - Gillumn, Richard F.
AU - Ford, Ian
AU - Thompson, Simon
AU - Davey Smith, George
PY - 2018/4/14
Y1 - 2018/4/14
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85045253163&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(18)30134-X
DO - 10.1016/S0140-6736(18)30134-X
M3 - Article
VL - 391
SP - 1513
EP - 1523
JO - Lancet
JF - Lancet
SN - 0140-6736
IS - 10129
ER -