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BMJ. 2018 May 29;361:k934. doi: 10.1136/bmj.k934.

Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study.

Author information

1
Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France.
2
Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
3
Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
4
Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
5
Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France.
6
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain.
7
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
8
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
9
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy.
10
Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
11
Danish Cancer Society Research Center, Copenhagen, Denmark.
12
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
13
Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland.
14
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
15
Andaluzian School of Public Health, University of Granada, Granada, Spain.
16
Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
17
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
18
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
19
Cancer Registry and Histopathology Department, Civic M P Arezzo Hospital, Ragusa, Italy.
20
Department of Clinical Sciences, Lund University, Malmö, Sweden.
21
Rennes University Hospital, Rennes, France.
22
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
23
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
24
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
25
Public Health Directorate of Asturias, Oviedo, Spain.
26
Hellenic Health Foundation, Athens, Greece.
27
WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, University of Athens Medical School, Athens, Greece.
28
Navarre Public Health Institute, Institute for Health Research (IdiSNA), Pamplona, Spain.
29
Research Network in Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain.
30
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
31
Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden.
32
Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Department of Medicine, Umeå University, Umeå, Sweden.
33
Department Medical Sciences, University of Torino, Italian Institute for Genomic Medicine -IIGM/HuGeF, Torino, Italy.
34
Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Gipuzkoa, Spain.
35
Department of Epidemiology and Public Health, University College London, London, UK.
36
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.
37
Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
38
Genetic Epidemiology Group, Genetics Section, International Agency for Research on Cancer, Lyon, France.

Abstract

OBJECTIVE:

To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke.

DESIGN:

Multicentre case-cohort study.

SETTING:

A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries.

PARTICIPANTS:

32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison.

MAIN OUTCOME MEASURES:

Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke).

RESULTS:

There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events.

CONCLUSIONS:

Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption.

PMID:
29844013
PMCID:
PMC5972779
DOI:
10.1136/bmj.k934
[Indexed for MEDLINE]
Free PMC Article

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