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

Ricci, Cristian; Wood, Angela; Muller, David; Gunter, Marc J.; Agudo, Antonio; Boeing, Heiner; Van Der Schouw, Yvonne T.; Warnakula, Samantha; Saieva, Calogero and Spijkerman, Annemieke, et al. (2018) In BMJ (Online) 361.
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... (More)

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.

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BMJ (Online)
volume
361
publisher
BMJ Publishing Group
external identifiers
  • scopus:85047630651
ISSN
0959-8146
DOI
10.1136/bmj.k934
language
English
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yes
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879d6d47-c7e6-4d1b-87a5-1aa04218a53d
date added to LUP
2018-06-18 15:05:15
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2019-08-14 04:18:36
@article{879d6d47-c7e6-4d1b-87a5-1aa04218a53d,
  abstract     = {<p>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.</p>},
  articleno    = {k934},
  author       = {Ricci, Cristian and Wood, Angela and Muller, David and Gunter, Marc J. and Agudo, Antonio and Boeing, Heiner and Van Der Schouw, Yvonne T. and Warnakula, Samantha and Saieva, Calogero and Spijkerman, Annemieke and Sluijs, Ivonne and Tjønneland, Anne and Kyrø, Cecilie and Weiderpass, Elisabete and Kühn, Tilman and Kaaks, Rudolf and Sánchez, Maria Jose and Panico, Salvatore and Agnoli, Claudia and Palli, Domenico and Tumino, Rosario and Engström, Gunnar and Melander, Olle and Bonnet, Fabrice and Boer, Jolanda M.A. and Key, Timothy J. and Travis, Ruth C. and Overvad, Kim and Verschuren, W. M.Monique and Quirós, J. Ramón and Trichopoulou, Antonia and Papatesta, Eleni Maria and Peppa, Eleni and Iribas, Conchi Moreno and Gavrila, Diana and Forslund, Ann Sofie and Jansson, Jan Håkan and Matullo, Giuseppe and Arriola, Larraitz and Freisling, Heinz and Lassale, Camille and Tzoulaki, Ioanna and Sharp, Stephen J. and Forouhi, Nita G. and Langenberg, Claudia and Saracci, Rodolfo and Sweeting, Michael and Brennan, Paul and Butterworth, Adam S. and Riboli, Elio},
  issn         = {0959-8146},
  language     = {eng},
  month        = {01},
  publisher    = {BMJ Publishing Group},
  series       = {BMJ (Online)},
  title        = {Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke : EPIC-CVD case-cohort study},
  url          = {http://dx.doi.org/10.1136/bmj.k934},
  volume       = {361},
  year         = {2018},
}