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Lancet. 2015 Nov 14;386(10007):1945-54. doi: 10.1016/S0140-6736(15)00235-4. Epub 2015 Sep 17.

Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study.

Collaborators (397)

Yusuf S, Rangarajan S, Teo KK, Chow CK, O'Donnell M, Mente A, Leong D, Smyth A, Joseph P, Islam S, Zhang M, Hu W, Ramasundarahettige C, Wong G, Dayal L, Casanova A, Dehghan M, Lewis G, DeJesus J, Mackie P, Chin SL, Hari D, Farago L, Kay I, Agapay D, Solano R, Ramacham S, Kandy N, Rimac J, Trottier S, ElSheikh W, Mustaha M, Tongana T, Aoucheva N, Swallow J, Ramezani E, Aliberti A, Lindeman J, McQueen M, Hall K, Keys J, Wang X, Keneth J, Devanath A, Diaz R, Orlandini A, Linetsky B, Toscanelli S, Casaccia G, Maini Cuneo JM, Rahman O, Yusuf R, Azad AK, Rabbani KA, Cherry HM, Mannan A, Hassan I, Talukdar AT, Tooheen RB, Khan MU, Sintaha M, Choudhury T, Haque R, Parvin S, Avezum A, Oliveira GB, Marcilio CS, Mattos AC, Teo K, Yusuf S, Dejesus J, Agapay D, Tongana T, Solano R, Kay I, Trottier S, Rimac J, Elsheikh W, Heldman L, Ramezani E, Dagenais G, Poirier P, Turbide G, Auger D, LeBlanc De Bluts A, Proulx MC, Cayer M, Bonneville N, Lear S, Gasevic D, Corber E, de Jong V, Vukmirovich I, Wielgosz A, Fodor G, Pipe A, Shane A, Lanas F, Seron P, Martinez S, Valdebenito A, Oliveros M, Wei L, Lisheng L, Chunming C, Xingyu W, Wenhua Z, Hongye Z, JiaXuan, Bo H, Yi S, Jian B, Xiuwen Z, Xiaohong C, Tao C, Hui C, Xiaohong C, Qing D, Xiaoru C, Qing D, Xinye H, Bo H, JiaXuan, Jian L, Juan L, Xu L, Bing R, Yi S, Wei W, Yang W, Jun Y, Yi Z, Hongye Z, Xiuwen Z, Manlu Z, Fanghong L, Jianfang W, Yindong L, Yan H, Liangqing Z, Baoxia G, Xiaoyang L, Shiying Z, BianRongwen, TianXiuzhen, Dong L, Di C, Jianguo W, Yize X, Tianlu L, Peng Z, Changlin D, Ning L, Xiaolan M, Yuqing Y, Rensheng L, Minfan F, Jing H, Yu L, Xiaojie X, Qiang Z, Lopez-Jaramillo P, Camacho Lopez PA, Garcia R, Jurado LJ, Gómez-Arbeláez D, Arguello JF, Dueñas R, Silva S, Pradilla LP, Ramirez F, Molina DI, Cure-Cure C, Perez M, Hernandez E, Arcos E, Fernandez S, Narvaez C, Paez J, Sotomayor A, Garcia H, Sanchez G, David T, Rico A, Mony P, Vaz M, Bharathi AV, Swaminathan S, Shankar A V Kurpad K, Jayachitra KG, Kumar N, Hospital HA, Mohan V, Deepa M, Parthiban K, Anitha M, Hemavathy S, Rahulashankiruthiyayan T, Anitha D, Sridevi K, Gupta R, Panwar RB, Mohan I, Rastogi P, Rastogi S, Bhargava R, Kumar R, Thakur JS, Patro B, Lakshmi PV, Mahajan R, Chaudary P, Raman Kutty V, Vijayakumar K, Ajayan K, Rajasree G, Renjini AR, Deepu A, Sandhya B, Asha S, Soumya HS, Kelishadi R, Bahonar A, Mohammadifard N, Heidari H, Yusoff K, Ismail TS, Ng KK, Devi A, Nasir NM, Yasin MM, Miskan M, Rahman EA, Arsad MK, Ariffin F, Razak SA, Majid FA, Bakar NA, Yacob MY, Zainon N, Salleh R, Ramli MK, Halim NA, Norlizan SR, Ghazali NM, Arshad MN, Razali R, Ali S, Othman HR, Hafar CW, Pit A, Danuri N, Basir F, Zahari SN, Abdullah H, Arippin MA, Zakaria NA, Noorhassim I, Hasni MJ, Azmi MT, Zaleha MI, Hazdi KY, Rizam AR, Sazman W, Azman A, Khatib R, Khammash U, Khatib A, Giacaman R, Iqbal R, Afridi A, Khawaja R, Raza A, Kazmi K, Dans A, Co HU, Sanchez JT, Pudol L, Zamora-Pudol C, Palileo-Villanueva LA, Aquino MR, Abaquin C, Pudol SL, Cabral ML, Zatonski W, Szuba A, Zatonska K, Ilow R, Ferus M, Regulska-Ilow B, Różańska D, Wolyniec M, AlHabib KH, Hersi A, Kashour T, Alfaleh H, Alshamir M, Altaradi HB, Alnobani O, Bafart A, Alkamel N, Ali M, Abdulrahman M, Nouri R, Kruger A, Voster HH, Schutte AE, Wentzel-Viljoen E, Eloff FC, de Ridder H, Moss H, Potgieter J, Roux AA, Watson M, de Wet G, Olckers A, Jerling JC, Pieters M, Hoekstra T, Puoane T, Igumbor E, Tsolekile L, Sanders D, Naidoo P, Steyn N, Peer N, Mayosi B, Rayner B, Lambert V, Levitt N, Kolbe-Alexander T, Ntyintyane L, Hughes G, Swart R, Fourie J, Muzigaba M, Xapa S, Gobile N, Ndayi K, Jwili B, Ndibaza K, Egbujie B, Rosengren A, Bengtsson Boström K, Lindblad U, Langkilde P, Gustavsson A, Andreasson M, Snällman M, Wirdemann L, Pettersson K, Moberg E, Yeates K, Sleeth J, Kilonzo K, Oguz A, Akalin AA, Calik KB, Imeryuz N, Temizhan A, Alphan E, Gunes E, Sur H, Karsidag K, Gulec S, Altuntas Y, Yusufali AM, Almahmeed W, Swidan H, Darwish EA, Hashemi AR, Al-Khaja N, Muscat-Baron JM, Ahmed SH, Mamdouh TM, Darwish WM, Abdelmotagali MH, Omer Awed SA, Movahedi GA, Hussain F, Al Shaibani H, Gharabou RI, Youssef DF, Nawati AZ, Abu Salah ZA, Abdalla RF, Al Shuwaihi SM, Al Omairi MA, Cadigal OD, Alejandrino RS, Chifamba J, Gwaunza L, Terera G, Mahachi C, Murambiwa P, Machiweni T, Mapanga R.

Author information

1
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Health Research Board Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland. Electronic address: andrew.smyth@phri.ca.
2
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
3
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Health Research Board Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland.
4
Institut Universitaire de Cardiologie et de Pneumologic de Quebec, Universitaire Laval, Quebec City, QC, Canada.
5
Facultad de Medicina, Universidad de La Frontera, Manuel Montt, Chile.
6
Sahlgrenska University Hospital and Östra Hospital, Diagnosvägen, Göteburg, Sweden.
7
Hypertension in Africa Research Team (HART) and MRC Research Unit on Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
8
Research Insitute, Fundacion Oftalmologica de Santander, Medical School, University of Santander, Floridablanca, Bucaramanga, Colombia.
9
Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
10
Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
11
Estudios Clínicos Latinoamérica, Rosario, Argentina.
12
Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
13
Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
14
Postgraduate Institute of Medical Education and Research, School of Public Health, Chandigarh, India.
15
Madras Diabetes Research Foundation, Madras, India.
16
Department of Internal Medicine, Wroclaw Medical University & 4th Military Hospital in Wroclaw, Wroclaw, Poland.
17
National Center for Cardiovascular Diseases, Cardiovascular Academy of Medical Sciences, Beijing, China.
18
European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, London, UK.

Abstract

BACKGROUND:

Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms, and previous studies were mostly done in high-income countries. We investigated associations between alcohol consumption and outcomes in a prospective cohort of countries at different economic levels in five continents.

METHODS:

We included information from 12 countries participating in the Prospective Urban Rural Epidemiological (PURE) study, a prospective cohort study of individuals aged 35-70 years. We used Cox proportional hazards regression to study associations with mortality (n=2723), cardiovascular disease (n=2742), myocardial infarction (n=979), stroke (n=817), alcohol-related cancer (n=764), injury (n=824), admission to hospital (n=8786), and for a composite of these outcomes (n=11,963).

FINDINGS:

We included 114,970 adults, of whom 12,904 (11%) were from high-income countries (HICs), 24,408 (21%) were from upper-middle-income countries (UMICs), 48,845 (43%) were from lower-middle-income countries (LMICs), and 28,813 (25%) were from low-income countries (LICs). Median follow-up was 4.3 years (IQR 3.0-6.0). Current drinking was reported by 36,030 (31%) individuals, and was associated with reduced myocardial infarction (hazard ratio [HR] 0.76 [95% CI 0.63-0.93]), but increased alcohol-related cancers (HR 1.51 [1.22-1.89]) and injury (HR 1.29 [1.04-1.61]). High intake was associated with increased mortality (HR 1.31 [1.04-1.66]). Compared with never drinkers, we identified significantly reduced hazards for the composite outcome for current drinkers in HICs and UMICs (HR 0.84 [0.77-0.92]), but not in LMICs and LICs, for which we identified no reductions in this outcome (HR 1.07 [0.95-1.21]; pinteraction<0.0001).

INTERPRETATION:

Current alcohol consumption had differing associations by clinical outcome, and differing associations by income region. However, we identified sufficient commonalities to support global health strategies and national initiatives to reduce harmful alcohol use.

FUNDING:

Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.

PMID:
26386538
DOI:
10.1016/S0140-6736(15)00235-4
[Indexed for MEDLINE]

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