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01-12-2021 | Myocardial Infarction | Research article

Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women

Authors: Chengyi Ding, Dara O’Neill, Steven Bell, Emmanuel Stamatakis, Annie Britton

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

Light-to-moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals; however, it is unclear whether this association is also present in those with disease. To examine the association between alcohol consumption and prognosis in individuals with pre-existing cardiovascular disease (CVD), we conducted a series of meta-analyses of new findings from three large-scale cohorts and existing published studies.

Methods

We assessed alcohol consumption in relation to all-cause mortality, cardiovascular mortality, and subsequent cardiovascular events via de novo analyses of 14,386 patients with a previous myocardial infarction, angina, or stroke in the UK Biobank Study (median follow-up 8.7 years, interquartile range [IQR] 8.0–9.5), involving 1640 deaths and 2950 subsequent events, and 2802 patients and 1257 deaths in 15 waves of the Health Survey for England 1994–2008 and three waves of the Scottish Health Survey 1995, 1998, and 2003 (median follow-up 9.5 years, IQR 5.7–13.0). This was augmented with findings from 12 published studies identified through a systematic review, providing data on 31,235 patients, 5095 deaths, and 1414 subsequent events. To determine the best-fitting dose-response association between alcohol and each outcome in the combined sample of 48,423 patients, models were constructed using fractional polynomial regression, adjusting at least for age, sex, and smoking status.

Results

Alcohol consumption was associated with all assessed outcomes in a J-shaped manner relative to current non-drinkers, with a risk reduction that peaked at 7 g/day (relative risk 0.79, 95% confidence interval 0.73–0.85) for all-cause mortality, 8 g/day (0.73, 0.64–0.83) for cardiovascular mortality and 6 g/day (0.50, 0.26–0.96) for cardiovascular events, and remained significant up to 62, 50, and 15 g/day, respectively. No statistically significant elevated risks were found at higher levels of drinking. In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated.

Conclusions

For secondary prevention of CVD, current drinkers may not need to stop drinking. However, they should be informed that the lowest risk of mortality and having another cardiovascular event is likely to be associated with lower levels of drinking, that is up to approximately 105g (or equivalent to 13 UK units, with one unit equal to half a pint of beer/lager/cider, half a glass of wine, or one measure of spirits) a week.

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Piepoli MF, Corrà U, Abreu A, Cupples M, Davos C, Doherty P, et al. Challenges in secondary prevention of cardiovascular diseases: a review of the current practice. Int J Cardiol. 2015;180:114–9. https://doi.org/10.1016/j.ijcard.2014.11.107.CrossRefPubMed

Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58(23):2432–46. https://doi.org/10.1016/j.jacc.2011.10.824.CrossRefPubMed

World Health Organization. Prevention of cardiovascular disease: pocket guidelines for assessment and management of cardiovascular risk. 2007. https://www.who.int/cardiovascular_diseases/guidelines/PocketGL.ENGLISH.AFR-D-E.rev1.pdf. Accessed 1 Mar 2021.

National Institute for Health and Care Excellence. Acute coronary syndromes. NICE guideline [NG185]. 2020. https://www.nice.org.uk/guidance/ng185/resources/acute-coronary-syndromes-pdf-66142023361477. Accessed 20 May 2021.

Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236. https://doi.org/10.1161/STR.0000000000000024.CrossRefPubMed

Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 2017;356:j909.CrossRefPubMedPubMedCentral

Bergmann MM, Rehm J, Klipstein-Grobusch K, Boeing H, Schütze M, Drogan D, et al. The association of pattern of lifetime alcohol use and cause of death in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Int J Epidemiol. 2013;42(6):1772–90. https://doi.org/10.1093/ije/dyt154.CrossRefPubMed

Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC, van Staveren WA. Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation. 2005;112(6):924–34. https://doi.org/10.1161/CIRCULATIONAHA.104.503995.CrossRefPubMed

Mukamal KJ, Clowry CM, Murray MM, Hendriks HFJ, Rimm EB, Sink KM, et al. Moderate alcohol consumption and chronic disease: the case for a long-term trial. Alcohol Clin Exp Res. 2016;40(11):2283–91. https://doi.org/10.1111/acer.13231.CrossRefPubMedPubMedCentral

10.

Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G. Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2010;55(13):1339–47. https://doi.org/10.1016/j.jacc.2010.01.006.CrossRefPubMed

11.

De Smedt D, Clays E, Annemans L, Doyle F, Kotseva K, Pajak A, et al. Health related quality of life in coronary patients and its association with their cardiovascular risk profile: results from the EUROASPIRE III survey. Int J Cardiol. 2013;168(2):898–903. https://doi.org/10.1016/j.ijcard.2012.10.053.CrossRefPubMed

12.

Levantesi G, Marfisi R, Mozaffarian D, Franzosi MG, Maggioni A, Nicolosi GL, et al. Wine consumption and risk of cardiovascular events after myocardial infarction: results from the GISSI-Prevenzione trial. Int J Cardiol. 2013;163(3):282–7. https://doi.org/10.1016/j.ijcard.2011.06.053.CrossRefPubMed

13.

Pai JK, Mukamal KJ, Rimm EB. Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study. Eur Heart J. 2012;33(13):1598–605. https://doi.org/10.1093/eurheartj/ehs047.CrossRefPubMedPubMedCentral

14.

Rosenbloom JI, Mukamal KJ, Frost LE, Mittleman MA. Alcohol consumption patterns, beverage type, and long-term mortality among women survivors of acute myocardial infarction. Am J Cardiol. 2012;109(2):147–52. https://doi.org/10.1016/j.amjcard.2011.08.021.CrossRefPubMed

15.

Mindell J, Biddulph JP, Hirani V, Stamatakis E, Craig R, Nunn S, et al. Cohort profile: the health survey for England. Int J epidemiol. 2012;41(6):1585–93. https://doi.org/10.1093/ije/dyr199.CrossRefPubMed

16.

Gray L, Batty GD, Craig P, Stewart C, Whyte B, Finlayson A, et al. Cohort profile: the Scottish health surveys cohort: linkage of study participants to routinely collected records for mortality, hospital discharge, cancer and offspring birth characteristics in three nationwide studies. Int J epidemiol. 2010;39(2):345–50. https://doi.org/10.1093/ije/dyp155.CrossRefPubMedPubMedCentral

17.

Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. Plos Med. 2015;12(3):e1001779. https://doi.org/10.1371/journal.pmed.1001779.CrossRefPubMedPubMedCentral

18.

Schnier C, Bush K, Nolan J, Sudlow C, UK Biobank Outcome Adjudication Group. Definitions of acute myocardial infarction and main myocardial infarction pathological types UK Biobank phase 1 outcomes adjudication. 2017. http://biobank.ctsu.ox.ac.uk/crystal/crystal/docs/alg_outcome_mi.pdf. Accessed 10 Oct 2019.

19.

Schnier C, Bush K, Nolan J, Sudlow C, UK Biobank Outcome Adjudication Group. Definitions of stroke for UK Biobank phase 1 outcomes adjudication. 2017. https://biobank.ndph.ox.ac.uk/showcase/showcase/docs/alg_outcome_stroke.pdf. Accessed 10 Oct 2019.

20.

Schnier C, Sudlow C, UK Biobank Follow-up and Outcomes Adjudication Group. 2017. Algorithmically-defined health outcomes. 2017. https://biobank.ndph.ox.ac.uk/showcase/showcase/docs/alg_outcome_main.pdf. Accessed 10 Oct 2019.

21.

Timpka S, Fraser A, Schyman T, Stuart JJ, Åsvold BO, Mogren I, et al. The value of pregnancy complication history for 10-year cardiovascular disease risk prediction in middle-aged women. Eur J Epidemiol. 2018;33(10):1003–10. https://doi.org/10.1007/s10654-018-0429-1.CrossRefPubMedPubMedCentral

22.

Dawes P, Cruickshanks KJ, Moore DR, Edmondson-Jones M, McCormack A, Fortnum H, et al. Cigarette smoking, passive smoking, alcohol consumption, and hearing loss. J Assoc Res Otolaryngol. 2014;15(4):663–74. https://doi.org/10.1007/s10162-014-0461-0.CrossRefPubMedPubMedCentral

23.

Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152(4):429–34. https://doi.org/10.1001/jamadermatol.2015.6264.CrossRefPubMed

24.

Bansal N, Fischbacher CM, Bhopal RS, Brown H, Steiner MF, Capewell S, et al. Myocardial infarction incidence and survival by ethnic group: Scottish Health and Ethnicity Linkage retrospective cohort study. BMJ Open. 2013;3(9):e003415. https://doi.org/10.1136/bmjopen-2013-003415.CrossRefPubMedPubMedCentral

25.

Office for National Statistics. Standard occupational classification 2010. 2010. https://www.ons.gov.uk/methodology/classificationsandstandards/standardoccupationalclassificationsoc/soc2010. Accessed 10 Oct 2019.

26.

Guggenheim JA, Williams C, Eye UKB, Vision C. Role of educational exposure in the association between myopia and birth order. JAMA Ophthalmol. 2015;133(12):1408–14. https://doi.org/10.1001/jamaophthalmol.2015.3556.CrossRefPubMedPubMedCentral

27.

Aragam KG, Chaffin M, Levinson RT, McDermott G, Choi SH, Shoemaker MB, et al. Phenotypic refinement of heart failure in a national biobank facilitates genetic discovery. Circulation. 2019;139(4):489–501. https://doi.org/10.1161/CIRCULATIONAHA.118.035774.CrossRef

28.

Papadakis M, Sharma S, Cox S, Sheppard MN, Panoulas VF, Behr ER. The magnitude of sudden cardiac death in the young: a death certificate-based review in England and Wales. Europace. 2009;11(10):1353–8. https://doi.org/10.1093/europace/eup229.CrossRefPubMed

29.

Smolina K, Wright FL, Rayner M, Goldacre MJ. Long-term survival and recurrence after acute myocardial infarction in England, 2004 to 2010. Circ Cardiovasc Qual Outcomes. 2012;5(4):532–40. https://doi.org/10.1161/CIRCOUTCOMES.111.964700.CrossRefPubMed

30.

House of Commons Science and Technology Committee. Alcohol guidelines, Eleventh Report of Session 2010–12. 2012 https://publications.parliament.uk/pa/cm201012/cmselect/cmsctech/1536/1536.pdf. Accessed 20 May 2021.

31.

Brown L, National Centre for Social Research. Health Survey for England 2015: adult alcohol consumption. 2016. http://cliftondavies.com/wp-content/uploads/2016/12/Health-Survey-England-adult-alcohol-consumption.pdf. Accessed 20 May 2021.

32.

Department of Health. UK Chief Medical Officers’ Low Risk Drinking Guidelines. 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf. Accessed 1 Mar 2021.

33.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentral

34.

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12. https://doi.org/10.1001/jama.283.15.2008.CrossRefPubMed

35.

Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G. Cardiovascular and overall mortality risk in relation to alcohol consumption in patients with cardiovascular disease. Circulation. 2010;121(17):1951–9. https://doi.org/10.1161/CIRCULATIONAHA.109.865840.CrossRefPubMed

36.

Aguilar D, Skali H, Moyé LA, Lewis EF, Gaziano JM, Rutherford JD, et al. Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction. J Am Coll Cardiol. 2004;43(11):2015–21. https://doi.org/10.1016/j.jacc.2004.01.042.CrossRefPubMed

37.

Jackson VA, Sesso HD, Buring JE, Gaziano JM. Alcohol consumption and mortality in men with preexisting cerebrovascular disease. Arch Intern Med. 2003;163(10):1189–93. https://doi.org/10.1001/archinte.163.10.1189.CrossRefPubMed

38.

Muntwyler J, Hennekens CH, Buring JE, Gaziano JM. Mortality and light to moderate alcohol consumption after myocardial infarction. Lancet. 1998;352(9144):1882–5. https://doi.org/10.1016/S0140-6736(98)06351-X.CrossRefPubMed

39.

Kalinowski A, Humphreys K. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction. 2016;111(7):1293–8. https://doi.org/10.1111/add.13341.CrossRefPubMed

40.

World Health Organization. International guide for monitoring alcohol consumption and related harm. 2000. https://apps.who.int/iris/bitstream/handle/10665/66529/WHO_MSD_MSB_00.4.pdf?sequence=1. Accessed 1 Mar 2021.

41.

Masunaga N, Kimura A, Miyataka M, Nishioka N, Hirano Y, Hayashi T, et al. Effects of alcohol consumption on cardiovascular events in male patients with healed myocardial infarction. Circ J. 2006;70(10):1263–8. https://doi.org/10.1253/circj.70.1263.CrossRefPubMed

42.

Berlin JA, Longnecker MP, Greenland S. Meta-analysis of epidemiologic dose-response data. Epidemiology. 1993;4(3):218–28. https://doi.org/10.1097/00001648-199305000-00005.CrossRefPubMed

43.

de Lorgeril M, Salen P, Martin J-L, Boucher F, Paillard F, de Leiris J. Wine drinking and risks of cardiovascular complications after recent acute myocardial infarction. Circulation. 2002;106:1465–9.

44.

Janszky I, Ljung R, Ahnve S, Hallqvist J, Bennet AM, Mukamal KJ. Alcohol and long-term prognosis after a first acute myocardial infarction: the SHEEP study. Eur Heart J. 2008;29(1):45–53. https://doi.org/10.1093/eurheartj/ehm509.CrossRefPubMed

45.

Mukamal KJ, Maclure M, Muller JE, Sherwood JB, Mittleman MA. Prior alcohol consumption and mortality following acute myocardial infarction. JAMA. 2001;285(15):1965–70. https://doi.org/10.1001/jama.285.15.1965.CrossRefPubMed

46.

Shaper AG, Wannamethee SG. Alcohol intake and mortality in middle aged men with diagnosed coronary heart disease. Heart. 2000;83(4):394–9. https://doi.org/10.1136/heart.83.4.394.CrossRefPubMedPubMedCentral

47.

Hamling J, Lee P, Weitkunat R, Ambühl M. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med. 2008;27(7):954–70. https://doi.org/10.1002/sim.3013.CrossRefPubMed

48.

Knott C, Bell S, Britton A. Alcohol consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of more than 1.9 million individuals from 38 observational studies. Diab Care. 2015;38(9):1804–12. https://doi.org/10.2337/dc15-0710.CrossRef

49.

Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 1 Mar 2021.

50.

Royston P, Sauerbrei W. Fractional Polynomials for One Variable. In: Multivariable model-building: a pragmatic approach to regression anaylsis based on fractional polynomials for modelling continuous variables. Chichester: Wiley; 2008. p. 71–98. https://doi.org/10.1002/9780470770771.ch4.CrossRef

51.

Bagnardi V, Zambon A, Quatto P, Corrao G. Flexible meta-regression functions for modeling aggregate dose-response data, with an application to alcohol and mortality. Am J Epidemiol. 2004;159(11):1077–86. https://doi.org/10.1093/aje/kwh142.CrossRefPubMed

52.

Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6(1):40–57. https://doi.org/10.1177/1536867X0600600103.CrossRef

53.

White IR. Multivariate random-effects meta-regression: updates to mvmeta. Stata J. 2011;11(2):255–70. https://doi.org/10.1177/1536867X1101100206.CrossRef

54.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.CrossRefPubMedPubMedCentral

55.

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. https://doi.org/10.1136/bmj.315.7109.629.CrossRefPubMedPubMedCentral

56.

Valmadrid CT, Klein R, Moss SE, Klein BEK, Cruickshanks KJ. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. JAMA. 1999;282(3):239–46. https://doi.org/10.1001/jama.282.3.239.CrossRefPubMed

57.

Hansen JL, Tolstrup JS, Jensen MK, Grønbæk M, Tjønneland A, Schmidt EB, et al. Alcohol intake and risk of acute coronary syndrome and mortality in men and women with and without hypertension. Eur J Epidemiol. 2011;26(6):439–47. https://doi.org/10.1007/s10654-011-9564-7.CrossRef

58.

Koppes L, Dekker J, Hendriks H, Bouter L, Heine R. Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients. Diabetologia. 2006;49(4):648–52. https://doi.org/10.1007/s00125-005-0127-x.CrossRefPubMed

59.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. https://health.gov/sites/default/files/2019-09/2015-2020_Dietary_Guidelines.pdf. Accessed 1 Mar 2021.

60.

Ng Fat L, Cable N, Shelton N. Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life course. Alcohol Clin Exp Res. 2015;39(1):166–74. https://doi.org/10.1111/acer.12596.CrossRefPubMedPubMedCentral

61.

Holton AE, Gallagher PJ, Ryan C, Fahey T, Cousins G. Consensus validation of the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria. BMJ Open. 2017;7(11):e017453. https://doi.org/10.1136/bmjopen-2017-017453.CrossRefPubMedPubMedCentral

62.

Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother. 2007;5(1):64–74. https://doi.org/10.1016/j.amjopharm.2007.03.006.CrossRefPubMedPubMedCentral

63.

Kabagambe EK, Kiage JN, Judd SE, Slaughter JC, Lipworth L, Sampson U, et al. Alcohol consumption, statin use and risk of all-cause mortality in the reasons for geographic and racial differences in stroke (REGARDS) cohort. Circulation. 2015;131(suppl_1):AP044.

64.

Roth JA, Bradley K, Thummel KE, Veenstra DL, Boudreau D. Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting. Pharmacoepidemiol Drug Saf. 2015;24(6):619–27. https://doi.org/10.1002/pds.3769.CrossRefPubMedPubMedCentral

65.

Huang C, Zhan J, Liu YJ, Li DJ, Wang SQ, He QQ. Association between alcohol consumption and risk of cardiovascular disease and all-cause mortality in patients with hypertension: a meta-analysis of prospective cohort studies. Mayo Clin Proc. 2014;89(9):1201–10. https://doi.org/10.1016/j.mayocp.2014.05.014.CrossRefPubMed

66.

Xi B, Veeranki SP, Zhao M, Ma C, Yan Y, Mi J. Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in U.S. adults. J Am Coll Cardiol. 2017;70(8):913–22. https://doi.org/10.1016/j.jacc.2017.06.054.CrossRefPubMed

67.

Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342(feb22 1):d671. https://doi.org/10.1136/bmj.d671.CrossRefPubMedPubMedCentral

68.

Naimi TS, Stadtmueller LA, Chikritzhs T, Stockwell T, Zhao J, Britton A, et al. Alcohol, age, and mortality: estimating selection bias due to premature death. J Stud Alcohol Drugs. 2019;80(1):63–8. https://doi.org/10.15288/jsad.2019.80.63.CrossRefPubMed

69.

Naimi TS, Stockwell T, Zhao J, Xuan Z, Dangardt F, Saitz R, et al. Selection biases in observational studies affect associations between ‘moderate’ alcohol consumption and mortality. Addiction. 2017;112(2):207–14. https://doi.org/10.1111/add.13451.CrossRefPubMed

70.

Gaziano JM, Gaziano TA, Glynn RJ, Sesso HD, Ajani UA, Stampfer MJ, et al. Light-to-moderate alcohol consumption and mortality in the Physicians’ Health Study enrollment cohort. J Am Coll Cardiol. 2000;35(1):96–105. https://doi.org/10.1016/S0735-1097(99)00531-8.CrossRefPubMed

71.

Boniface S, Scholes S, Shelton N, Connor J. Assessment of non-response bias in estimates of alcohol consumption: applying the continuum of resistance model in a general population survey in England. Plos One. 2017;12(1):e0170892. https://doi.org/10.1371/journal.pone.0170892.CrossRefPubMedPubMedCentral

72.

Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ. 2015;350(feb10 2):h384. https://doi.org/10.1136/bmj.h384.CrossRefPubMedPubMedCentral

73.

Bardach AE, Alcaraz AO, Ciapponi A, Garay OU, Riviere AP, Palacios A, et al. Alcohol consumption's attributable disease burden and cost-effectiveness of targeted public health interventions: a systematic review of mathematical models. BMC Public Health. 2019;19(1):1378. https://doi.org/10.1186/s12889-019-7771-4.CrossRefPubMedPubMedCentral

74.

Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, et al. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet. 2019;393(10183):1831–42. https://doi.org/10.1016/S0140-6736(18)31772-0.CrossRefPubMedPubMedCentral

75.

Smyth A, Teo KK, Rangarajan S, O'Donnell M, Zhang X, Rana P, et al. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet. 2015;386(10007):1945–54. https://doi.org/10.1016/S0140-6736(15)00235-4.CrossRefPubMed

76.

Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23. https://doi.org/10.1016/S0140-6736(18)30134-X.CrossRefPubMedPubMedCentral

77.

Roerecke M, Rehm J. Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Med. 2014;12(1):182. https://doi.org/10.1186/s12916-014-0182-6.CrossRefPubMedPubMedCentral

78.

Holmes J, Angus C, Meier PS, Buykx P, Brennan A. How should we set consumption thresholds for low risk drinking guidelines? Achieving objectivity and transparency using evidence, expert judgement and pragmatism. Addiction. 2019;114(4):590–600. https://doi.org/10.1111/add.14381.CrossRefPubMed

79.

LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: a statement of the American Society of Clinical Oncology. J Clin Oncol. 2018;36(1):83–93. https://doi.org/10.1200/JCO.2017.76.1155.CrossRefPubMed

Title: Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women
Authors: Chengyi Ding
Dara O’Neill
Steven Bell
Emmanuel Stamatakis
Annie Britton
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Myocardial Infarction
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02040-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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