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Meta-Analysis
. 2018 Aug 22;16(1):124.
doi: 10.1186/s12916-018-1123-6.

Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data

Dara O'Neill  1 , Annie Britton  2 , Mary K Hannah  3 , Marcel Goldberg  4 , Diana Kuh  2   5 , Kay Tee Khaw  6 , Steven Bell  7
Affiliations
Meta-Analysis

Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data

Dara O'Neill et al. BMC Med. .

Abstract

Background: Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD.

Methods: Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants' intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics.

Results: Compared to consistently moderate drinkers (males: 1-168 g ethanol/week; females: 1-112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02-1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13-1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21-1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors.

Conclusions: Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake.

Trial registration: ClinicalTrials.gov, NCT03133689 .

Keywords: Alcohol; Coronary heart disease; IPD meta-analysis; Longitudinal design.

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Conflict of interest statement

Ethics approval and consent to participate

All data used and analysed in this study were secondary data that had previously been anonymised by the individual cohort studies. Ethical approval for the EPIC-N study was received from the Norwich District Health Authority Ethics Committee. The GAZEL study received approval from the Commission Nationale Informatique et Liberté. The NSHD was granted ethical approval from the Greater Manchester Local Research Ethics Committee and the Scotland A Research Ethics Committee. Approval for the Twenty-07 Study was received from the ethical sub-committee of the West of Scotland Medical Committee and the University of Glasgow’s Ethics Committee for Non-Clinical Research Involving Human Subjects. The WII study received approval from the University College London Medical School Committee on the Ethics of Human Research. All participants in these studies gave written informed consent.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Cohort description and participant selection flowchart. CHD coronary heart disease, EPIC-N European Prospective Investigation of Cancer, Norfolk, GAZEL Gaz et Electricité, T07-1930s West of Scotland Twenty-07 Study 1930s, T07-1950s West of Scotland Twenty-07 Study 1950s, WII Whitehall II
Fig. 2
Fig. 2
Association of drinker type (single intake measurement) with incident (fatal or non-fatal) CHD using maximal adjustment for confounding. Adjustment variables comprised age, sex (reference category: male), socioeconomic position (reference category: intermediate), smoker status (reference category: non-smoker) and intake assessment interval. CHD coronary heart disease, CI confidence interval, HR hazard ratio
Fig. 3
Fig. 3
Association of drinker type (longitudinal intake measurement) with incident (fatal or non-fatal) CHD using maximal adjustment for confounding. Adjustment variables comprised age, sex (reference category: male), socioeconomic position (reference category: intermediate), smoker status (reference category: non-smoker) and intake assessment interval. CHD coronary heart disease, CI confidence interval, HR hazard ratio
Fig. 4
Fig. 4
Age-stratified association of drinker type (longitudinal intake measurement) with incident (fatal or non-fatal) CHD using maximal adjustment for confounding. Adjustment variables comprised age, sex (reference category: male), socioeconomic position (reference category: intermediate), smoker status (reference category: non-smoker) and intake assessment interval. CHD coronary heart disease, CI confidence interval, HR hazard ratio
Fig. 5
Fig. 5
Sex-stratified association of drinker type (longitudinal intake measurement) with incident (fatal or non-fatal) CHD using maximal adjustment for confounding. Adjustment variables comprised age, socioeconomic position (reference category: intermediate), smoker status (reference category: non-smoker) and intake assessment interval. CHD coronary heart disease, CI confidence interval, HR hazard ratio
See this image and copyright information in PMC

References

    1. Roerecke M, Rehm J. Chronic heavy drinking and ischaemic heart disease: a systematic review and meta-analysis. Open Heart. 2014;1:e000135. doi: 10.1136/openhrt-2014-000135. - DOI - PMC - PubMed
    1. Ruidavets J-B, Ducimetière P, Evans A, Montaye M, Haas B, Bingham A, et al. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the prospective epidemiological study of myocardial infarction (PRIME) BMJ. 2010;341:c6077. doi: 10.1136/bmj.c6077. - DOI - PMC - PubMed
    1. Stockwell T, Chikritzhs T. Commentary: another serious challenge to the hypothesis that moderate drinking is good for health? Int J Epidemiol. 2013;42:1792–1794. doi: 10.1093/ije/dyt217. - DOI - PubMed
    1. Thompson PL. J-curve revisited: cardiovascular benefits of moderate alcohol use cannot be dismissed. Med J Aust. 2013;198:419–422. doi: 10.5694/mja12.10922. - DOI - PubMed
    1. de Gaetano G, Costanzo S. Alcohol and health: Praise of the J curves. J Am Coll Cardiol. 2017;70:923 LP–923925. doi: 10.1016/j.jacc.2017.07.710. - DOI - PubMed

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