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Meta-Analysis
. 2024 May 14;15(1):4082.
doi: 10.1038/s41467-024-47632-7.

A burden of proof study on alcohol consumption and ischemic heart disease

Sinclair Carr  1 , Dana Bryazka  2 , Susan A McLaughlin  2 , Peng Zheng  2   3 , Sarasvati Bahadursingh  4 , Aleksandr Y Aravkin  2   3   5 , Simon I Hay  2   3 , Hilary R Lawlor  2 , Erin C Mullany  2 , Christopher J L Murray  2   3 , Sneha I Nicholson  2 , Jürgen Rehm  6   7   8   9   10   11   12   13 , Gregory A Roth  2   3   14 , Reed J D Sorensen  2 , Sarah Lewington  4 , Emmanuela Gakidou  2   3
Affiliations
Meta-Analysis

A burden of proof study on alcohol consumption and ischemic heart disease

Sinclair Carr et al. Nat Commun. .

Abstract

Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk - specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males - while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.

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Conflict of interest statement

G.A.R. has received support for this manuscript from the Bill and Melinda Gates Foundation [OPP1152504]. S.L. has received grants or contracts from the UK Medical Research Council [MR/T017708/1], CDC Foundation [project number 996], World Health Organization [APW No 2021/1194512], and is affiliated with the NIHR Oxford Biomedical Research Centre. The University of Oxford’s Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) is supported by core grants from the Medical Research Council [Clinical Trial Service Unit A310] and the British Heart Foundation [CH/1996001/9454]. The CTSU receives research grants from industry that are governed by University of Oxford contracts that protect its independence and has a staff policy of not taking personal payments from industry. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Relative risk of alcohol consumption on ischemic heart disease, based on data from all conventional observational (cohort and case-control) studies.
The panels show the log(relative risk) function, the relative risk function, and a modified funnel plot showing the residuals (relative to 0) on the x-axis and the estimated standard error that includes the reported standard error and between-study heterogeneity on the y-axis. RR relative risk, UI uncertainty interval. Source data are provided as a Source Data file.
Fig. 2
Fig. 2. Relative risk of alcohol consumption on ischemic heart disease, based on data from case-control studies.
The panels show the log(relative risk) function, the relative risk function, and a modified funnel plot showing the residuals (relative to 0) on the x-axis and the estimated standard deviation that includes the reported standard deviation and between-study heterogeneity on the y-axis. RR relative risk, UI uncertainty interval. Source data are provided as a Source Data file.
Fig. 3
Fig. 3. Relative risk of alcohol consumption on ischemic heart disease, based on data from cohort studies.
The panels show the log(relative risk) function, the relative risk function, and a modified funnel plot showing the residuals (relative to 0) on the x-axis and the estimated standard deviation that includes the reported standard deviation and between-study heterogeneity on the y-axis. RR relative risk, UI uncertainty interval. Source data are provided as a Source Data file.
Fig. 4
Fig. 4. Relative risk of alcohol consumption on ischemic heart disease, based on data from Mendelian randomization studies.
The panels show the log(relative risk) function, the relative risk function, and a modified funnel plot showing the residuals (relative to 0) on the x-axis and the estimated standard deviation that includes the reported standard deviation and between-study heterogeneity on the y-axis. RR relative risk, UI uncertainty interval. Source data are provided as a Source Data file.
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