Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes. Design Systematic review and meta-analysis. Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings. Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke. Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis. Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)). Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

[1]  M. Thun,et al.  The role of aspirin in cancer prevention , 2012, Nature Reviews Clinical Oncology.

[2]  An Pan,et al.  Red meat consumption and mortality: results from 2 prospective cohort studies. , 2012, Archives of internal medicine.

[3]  Andrew T Chan,et al.  Long-term use of aspirin and the risk of gastrointestinal bleeding. , 2011, The American journal of medicine.

[4]  A. Wolk,et al.  Dietary zinc and prostate cancer survival in a Swedish cohort. , 2011, The American journal of clinical nutrition.

[5]  W. Ghali,et al.  Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies , 2011, BMJ : British Medical Journal.

[6]  M. Pittler.  Systematic Reviews in Health Care: Meta‐analysis in Context , 2010 .

[7]  A. Klatsky.  Alcohol and cardiovascular mortality: common sense and scientific truth. , 2010, Journal of the American College of Cardiology.

[8]  S. McKenna,et al.  Curcumin induces apoptosis-independent death in oesophageal cancer cells , 2009, British Journal of Cancer.

[9]  J. Buring,et al.  Alcohol Consumption and Risk of Cardiovascular Disease and Death in Women: Potential Mediating Mechanisms , 2009, Circulation.

[10]  K. Reynolds,et al.  Alcohol consumption and risk of coronary heart disease among Chinese men. , 2009, International journal of cardiology.

[11]  M. Inoue,et al.  Alcohol consumption, social support, and risk of stroke and coronary heart disease among Japanese men: the JPHC Study. , 2009, Alcoholism, clinical and experimental research.

[12]  G. Smith,et al.  Alcohol consumption and mortality and hospital admissions in men from the Midspan collaborative cohort study. , 2008, Addiction.

[13]  J. Manson,et al.  Primary Prevention of Stroke by Healthy Lifestyle , 2008, Circulation.

[14]  Tom R. Gaunt,et al.  Alcohol dehydrogenase type 1C (ADH1C) variants, alcohol consumption traits, HDL-cholesterol and risk of coronary heart disease in women and men: British Women's Heart and Health Study and Caerphilly cohorts. , 2008, Atherosclerosis.

[15]  P. Schnohr,et al.  The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality. , 2007, European heart journal.

[16]  K. Reynolds,et al.  Alcohol consumption and risk for stroke among Chinese men , 2007, Annals of neurology.

[17]  D. English,et al.  Alcohol consumption and cardiovascular mortality accounting for possible misclassification of intake: 11-year follow-up of the Melbourne Collaborative Cohort Study. , 2007, Addiction.

[18]  X. Shu,et al.  Joint effect of cigarette smoking and alcohol consumption on mortality. , 2007, Preventive medicine.

[19]  K. McPherson.  Moderate alcohol consumption and cancer , 2007 .

[20]  T. Chikritzhs,et al.  Moderate alcohol use and reduced mortality risk: systematic error in prospective studies and new hypotheses. , 2007, Annals of epidemiology.

[21]  L. Beilin,et al.  Alcohol intake and incidence of coronary disease in Australian aborigines. , 2006, Alcohol and alcoholism.

[22]  J. Cerhan,et al.  The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history , 2007, Journal of General Internal Medicine.

[23]  N. Pratt,et al.  Tobacco and alcohol‐related mortality in men: estimates from the Australian cohort of petroleum industry workers , 2006, Australian and New Zealand Journal of Public Health.

[24]  K. Overvad,et al.  Prospective study of alcohol drinking patterns and coronary heart disease in women and men , 2006, BMJ : British Medical Journal.

[25]  Brian Mullen,et al.  Sufficiency and stability of evidence for public health interventions using cumulative meta-analysis. , 2006, American journal of public health.

[26]  M. Grønbæk,et al.  Food buying habits of people who buy wine or beer: cross sectional study , 2006, BMJ : British Medical Journal.

[27]  T. Chikritzhs,et al.  Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies , 2006 .

[28]  L. Kuller,et al.  Alcohol Consumption and Risk of Coronary Heart Disease in Older Adults: The Cardiovascular Health Study , 2006, Journal of the American Geriatrics Society.

[29]  R. Sacco,et al.  Moderate Alcohol Consumption Reduces Risk of Ischemic Stroke: The Northern Manhattan Study , 2006, Stroke.

[30]  J. Gaziano,et al.  Low-Dose Aspirin in the Primary Prevention of Cancer. The Women’s Health Study: A Randomized Controlled Trial , 2005 .

[31]  A. Tamakoshi,et al.  Alcohol consumption and mortality among middle-aged and elderly Japanese men and women. , 2005, Annals of epidemiology.

[32]  L. Kuller,et al.  Alcohol Use and Risk of Ischemic Stroke Among Older Adults: The Cardiovascular Health Study , 2005, Stroke.

[33]  J. Connett,et al.  Difficulty in demonstrating a risk from drinking pattern in fourteen years of coronary heart disease morbidity and mortality: the Lung Health Study. , 2005, Addictive behaviors.

[34]  E. Rimm,et al.  Alcohol and Risk for Ischemic Stroke in Men: The Role of Drinking Patterns and Usual Beverage , 2005, Annals of Internal Medicine.

[35]  R. Doll,et al.  Mortality in relation to alcohol consumption: a prospective study among male British doctors. , 2004, International journal of epidemiology.

[36]  A. Hofman,et al.  Alcohol and mortality , 1994, European Journal of Epidemiology.

[37]  K. Paunović,et al.  Alcohol consumption and mortality in Serbia: twenty-year follow-up study. , 2004, Croatian medical journal.

[38]  Y. Li,et al.  [Alcohol consumption and incidence of ischemic stroke in male Chinese]. , 2004, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[39]  D. Annane,et al.  Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis , 2004, BMJ : British Medical Journal.

[40]  A. Folsom,et al.  Association between alcoholic beverage consumption and incidence of coronary heart disease in whites and blacks: the Atherosclerosis Risk in Communities Study. , 2004, American journal of epidemiology.

[41]  Sander Greenland,et al.  Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. , 2004, American journal of epidemiology.

[42]  A. Evans,et al.  Alcohol consumption and cardiovascular disease: differential effects in France and Northern Ireland. The PRIME study , 2004, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[43]  D. Horsman,et al.  Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. , 2004, Journal of the National Cancer Institute.

[44]  W. Drygas,et al.  Relationship between alcohol consumption and cardiovascular mortality--the Warsaw Pol-MONICA Project. , 2004, Kardiologia polska.

[45]  Giovanni Corrao,et al.  A meta-analysis of alcohol consumption and the risk of 15 diseases. , 2004, Preventive medicine.

[46]  P. Heuschmann,et al.  Changes in alcohol intake and risk of coronary heart disease and all-cause mortality in the MONICA/KORA-Augsburg cohort 1987-97 , 2004, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[47]  R. Sacco,et al.  The Northern Manhattan Study , 2004 .

[48]  Y. Kiyohara.  [The Hisayama study]. , 2004, Nihon rinsho. Japanese journal of clinical medicine.

[49]  P. Diem,et al.  Effects of alcohol consumption on mortality in patients with Type 2 diabetes mellitus , 2003, Diabetologia.

[50]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[51]  Xiaonan Xue,et al.  Estimating the relative risk in cohort studies and clinical trials of common outcomes. , 2003, American journal of epidemiology.

[52]  C. Waters,et al.  Prostate cancer--testing, incidence, surgery and mortality. , 2003, Health reports.

[53]  G. Beck,et al.  A randomized trial of aspirin to prevent colorectal adenomas. , 2003, The New England journal of medicine.

[54]  K. Reynolds,et al.  Alcohol consumption and risk of stroke: a meta-analysis. , 2003, JAMA.

[55]  E. Rimm,et al.  Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. , 2003, The New England journal of medicine.

[56]  B. Nordestgaard,et al.  The Copenhagen City Heart Study , 2003 .

[57]  F. Couch,et al.  Oral contraceptives and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. , 2002, Journal of the National Cancer Institute.

[58]  K. Wilkins.  Moderate alcohol consumption and heart disease. , 2002, Health reports.

[59]  J. Ranstam,et al.  Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease , 2002, The Lancet.

[60]  J. Cuzick,et al.  Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial , 2002, The Lancet.

[61]  Licia Iacoviello,et al.  Meta-Analysis of Wine and Beer Consumption in Relation to Vascular Risk , 2002, Circulation.

[62]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[63]  G. Friedman,et al.  Alcohol Drinking and Risk of Hemorrhagic Stroke , 2002, Neuroepidemiology.

[64]  R. D'Agostino,et al.  Alcohol Consumption and Risk of Ischemic Stroke: The Framingham Study , 2002, Stroke.

[65]  E. Riboli,et al.  Meat consumption and colorectal cancer risk: Dose‐response meta‐analysis of epidemiological studies , 2002, International journal of cancer.

[66]  J. Connett,et al.  Alcohol volume, drinking pattern, and cardiovascular disease morbidity and mortality: is there a U-shaped function? , 2002, American journal of epidemiology.

[67]  M. Trevisan,et al.  Drinking pattern and mortality: the Italian Risk Factor and Life Expectancy pooling project. , 2001, Annals of epidemiology.

[68]  G Corrao,et al.  Alcohol and coronary heart disease: a meta-analysis. , 2000, Addiction.

[69]  G A Colditz,et al.  Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. , 2000, Circulation.

[70]  P. Jousilahti,et al.  Serum gamma-glutamyl transferase, self-reported alcohol drinking, and the risk of stroke. , 2000, Stroke.

[71]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology - A proposal for reporting , 2000 .

[72]  C. Anderson,et al.  Predictors of death and vascular events in the elderly : the Perth Community Stroke Study. , 2000, Stroke.

[73]  H. Iso,et al.  Prospective study on alcohol intake and risk of subarachnoid hemorrhage among Japanese men and women. , 2000, Alcoholism, clinical and experimental research.

[74]  J. Manson,et al.  Light-to-moderate alcohol consumption and mortality in the Physicians' Health Study enrollment cohort. , 2000, Journal of the American College of Cardiology.

[75]  E. Rimm,et al.  Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors , 1999, BMJ.

[76]  J. Buring,et al.  Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. , 1999, The New England journal of medicine.

[77]  R. Detrano,et al.  Alcohol consumption, coronary calcium, and coronary heart disease events. , 1999, The American journal of cardiology.

[78]  T. Cleophas.  Wine, beer and spirits and the risk of myocardial infarction: a systematic review. , 1999, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[79]  D. Albanes,et al.  Alcohol consumption and stroke incidence in male smokers. , 1999, Circulation.

[80]  G. Siest,et al.  Wine, beer, and mortality in middle-aged men from eastern France. , 1999, Archives of internal medicine.

[81]  J. Manson,et al.  Moderate alcohol consumption and the risk of sudden cardiac death among US male physicians. , 1999, Circulation.

[82]  R. Klein,et al.  Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. , 1999, JAMA.

[83]  T. Powles.  COMMENT ON: TAMOXIFEN FOR PREVENTION OF BREAST CANCER : REPORT OF THE NATIONAL SURGICAL ADJUVANT BREAST AND BOWEL PROJECT P-1 STUDY , 1999 .

[84]  A. Tjønneland,et al.  Wine intake and diet in a random sample of 48763 Danish men and women. , 1999, The American journal of clinical nutrition.

[85]  C K Redmond,et al.  Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. , 1999, Journal of the National Cancer Institute.

[86]  T. Truelsen,et al.  Intake of beer, wine, and spirits and risk of stroke : the copenhagen city heart study. , 1998, Stroke.

[87]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[88]  P Corey,et al.  The Impact of Excluding Non‐Leisure Energy Expenditure on the Relation between Physical Activity and Mortality in Women , 1998, Epidemiology.

[89]  L. Kolonel,et al.  Alcohol Intake, Body Weight, and Mortality in a Multiethnic Prospective Cohort , 1998, Epidemiology.

[90]  H. Jick,et al.  Tamoxifen and risk of idiopathic venous thromboembolism. , 1998, British journal of clinical pharmacology.

[91]  J. Abernathy,et al.  Association of alcohol consumption to morality in middle-aged U.S. and Russian men and women. , 1998, Annals of epidemiology.

[92]  H. Iso,et al.  Alcohol intake and premature coronary heart disease in urban Japanese men. , 1998, American journal of epidemiology.

[93]  Alan D. Lopez,et al.  Alcohol consumption and mortality among middle-aged and elderly U.S. adults. , 1997, The New England journal of medicine.

[94]  C. Sempos,et al.  Alcohol consumption and coronary heart disease morbidity and mortality. , 1997, American journal of epidemiology.

[95]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[96]  G. Friedman,et al.  Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. , 1997, The American journal of cardiology.

[97]  L. Tenkanen,et al.  Alcohol and coronary heart disease: the roles of HDL‐cholesterol and smoking , 1997, Journal of internal medicine.

[98]  Niklas Hammar,et al.  Alcohol consumption, drinking pattern and acute myocardial infarction. A case referent study based on the Swedish Twin Register , 1997, Journal of internal medicine.

[99]  J. Manson,et al.  Prospective study of moderate alcohol consumption and mortality in US male physicians. , 1997, Archives of internal medicine.

[100]  B. Henderson,et al.  Follow up study of moderate alcohol intake and mortality among middle aged men in Shanghai, China , 1997, BMJ.

[101]  Y. Friedlander,et al.  Alcohol intake and survival in the elderly: a 77 month follow-up in the Dubbo study. , 1996, Australian and New Zealand journal of medicine.

[102]  E. Rimm,et al.  Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits? , 1996, BMJ.

[103]  H. Hein,et al.  Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of ischaemic heart disease: six year follow up in the Copenhagen male study , 1996, BMJ.

[104]  R. Westendorp,et al.  Alcohol consumption and mortality among women. , 1995, The New England journal of medicine.

[105]  M. G. Verdier,et al.  Alcohol consumption and stroke mortality. 20-year follow-up of 15,077 men and women. , 1995, Stroke.

[106]  P. Schnohr,et al.  Mortality associated with moderate intakes of wine, beer, or spirits , 1995, BMJ.

[107]  H. Iso,et al.  Alcohol intake and the risk of cardiovascular disease in middle-aged Japanese men. , 1995, Stroke.

[108]  M. Fujishima,et al.  The impact of alcohol and hypertension on stroke incidence in a general Japanese population. The Hisayama Study. , 1995, Stroke.

[109]  C. Rao,et al.  Chemoprevention of colon carcinogenesis by dietary curcumin, a naturally occurring plant phenolic compound. , 1995, Cancer research.

[110]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[111]  Gordon H. Guyatt,et al.  Users' Guides to the Medical Literature: V. How to Use an Article About Prognosis , 1994 .

[112]  P Tugwell,et al.  Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. , 1994, JAMA.

[113]  R. Rubin,et al.  Alcohol and platelet function. , 1994, Alcoholism, clinical and experimental research.

[114]  C J Cherpitel,et al.  Alcohol, injury, and risk-taking behavior: data from a national sample. , 1993, Alcoholism, clinical and experimental research.

[115]  D. Wagener,et al.  Alcohol Consumption and Risk of Ischemic Heart Disease in Women , 1993, Archives of internal medicine.

[116]  M. Knuiman,et al.  Alcohol and mortality in Busselton, Western Australia. , 1993, American journal of epidemiology.

[117]  M. Maclure.  Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. , 1993, Epidemiologic reviews.

[118]  C. Hennekens,et al.  Light to Moderate Alcohol Consumption and Mortality in the Elderly , 1992, Journal of the American Geriatrics Society.

[119]  J. Cutler,et al.  Alcohol Use and Mortality from Coronary Heart Disease: The Role of High-Density Lipoprotein Cholesterol , 1992, Annals of Internal Medicine.

[120]  J. Cutler,et al.  Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. The Multiple Risk Factor Intervention Trial Research Group. , 1992, Annals of internal medicine.

[121]  P. Allhoff,et al.  The Honolulu Heart Program , 1991 .

[122]  G. Friedman,et al.  Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. , 1990, The American journal of cardiology.

[123]  L. Garfinkel,et al.  Alcohol Drinking and Mortality among Men Enrolled in an American Cancer Society Prospective Study , 1990, Epidemiology.

[124]  C. Turner,et al.  How much alcohol is in a 'standard drink'? An analysis of 125 studies. , 1990, British journal of addiction.

[125]  J. Woo,et al.  Risk factors predisposing to stroke in an elderly Chinese population--a longitudinal study. , 1990, Neuroepidemiology.

[126]  P. Puska,et al.  Alcohol consumption and mortality in aging or aged Finnish men. , 1989, Journal of clinical epidemiology.

[127]  L. Garfinkel,et al.  Alcohol and breast cancer: a cohort study. , 1988, Preventive medicine.

[128]  A. Reunanen,et al.  Alcohol consumption and sudden coronary death in middle-aged Finnish men. , 2009, Acta medica Scandinavica.

[129]  C. N. Ross.  Alcohol and ischaemic heart disease in middle aged British men , 1987, British medical journal.

[130]  S. Pocock,et al.  Alcohol and ischaemic heart disease in middle aged British men. , 1987 .

[131]  S. Kono,et al.  Alcohol and mortality: a cohort study of male Japanese physicians. , 1986, International journal of epidemiology.

[132]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[133]  A. Kimball,et al.  Coronary heart disease mortality and alcohol consumption in Framingham. , 1986, American journal of epidemiology.

[134]  D. Reed,et al.  Alcohol and hemorrhagic stroke. The Honolulu Heart Program. , 1986, JAMA.

[135]  T. Gordon,et al.  Drinking and coronary heart disease: the Albany Study. , 1985, American heart journal.

[136]  W. Willett,et al.  Moderate alcohol and decreased cardiovascular mortality in an elderly cohort. , 1985, American heart journal.

[137]  R. Havlik,et al.  Alcohol and coronary heart disease in Puerto Rico. , 1983, American journal of epidemiology.

[138]  W. Kannel,et al.  Drinking habits and cardiovascular disease: the Framingham Study. , 1983, American heart journal.

[139]  J. Salonen,et al.  Intake of spirits and beer and risk of myocardial infarction and death--a longitudinal study in Eastern Finland. , 1983, Journal of chronic diseases.

[140]  K. Yano,et al.  Alcohol and mortality: the Honolulu Heart Study. , 1980, The American journal of medicine.

[141]  A. Belanger,et al.  The Framingham study. , 1976, British medical journal.