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

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  • Cristian Ricci, Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa., South Africa
  • Angela Wood, Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., United Kingdom
  • David Muller, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., United Kingdom
  • Marc J Gunter, Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France. jenabm@iarc.fr., France
  • Antonio Agudo, Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), 08908 Barcelona, Spain., Spain
  • Heiner Boeing, Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany, karina.meidtner@dife.de., Germany
  • Yvonne T van der Schouw, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Netherlands
  • Samantha Warnakula, Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., United Kingdom
  • Calogero Saieva, Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy., Italy
  • Annemieke Spijkerman, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Netherlands
  • Ivonne Sluijs, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Netherlands
  • Anne Tjønneland, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Denmark
  • Cecilie Kyrø, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Denmark
  • Elisabete Weiderpass, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland., Norway
  • Tilman Kühn, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany., Germany
  • Rudolf Kaaks, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany., Germany
  • Maria-Jose Sánchez, Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain., Spain
  • Salvatore Panico, Department of Clinical Medicine and Surgery, Division of Gastroenterology, Federico II University Hospital School of Medicine, Naples, Italy., Italy
  • Claudia Agnoli, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Italy
  • Domenico Palli, Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy., Italy
  • Rosario Tumino, Civic-M.P. Arezzo Hospital
  • ,
  • Gunnar Engström, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Sweden
  • Olle Melander, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Sweden
  • Fabrice Bonnet, Rennes University Hospital, Rennes, France., France
  • Jolanda M A Boer, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Netherlands
  • Timothy J Key, Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK., United Kingdom
  • Ruth C Travis, Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK., United Kingdom
  • Kim Overvad
  • W M Monique Verschuren, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Netherlands
  • J Ramón Quirós, Public Health Directorate, Asturias, General Elorza 32, 33001 Oviedo, Spain., Spain
  • Antonia Trichopoulou, WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, University of Athens Medical School, Athens, Greece., Greece
  • Eleni-Maria Papatesta, WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, University of Athens Medical School, Athens, Greece., Greece
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Conchi Moreno Iribas, Research Network in Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain., Spain
  • Diana Gavrila, Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Spain
  • Ann-Sofie Forslund, Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden., Sweden
  • Jan-Håkan Jansson, Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Department of Medicine, Umeå University, Umeå, Sweden., Sweden
  • Giuseppe Matullo, Department Medical Sciences, University of Torino, Italian Institute for Genomic Medicine -IIGM/HuGeF, Torino, Italy., Italy
  • Larraitz Arriola, Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, Calle Doctor Begiristain, 20014 Donostia/Gipuzkoa, Spain., Spain
  • Heinz Freisling, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France., France
  • Camille Lassale, Department of Epidemiology and Public Health, University College London, United Kingdom
  • Ioanna Tzoulaki, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, 45110, Greece., Greece
  • Stephen J Sharp, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K., United Kingdom
  • Nita G Forouhi, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K., United Kingdom
  • Claudia Langenberg, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K., United Kingdom
  • Rodolfo Saracci, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France., France
  • Michael Sweeting, Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., United Kingdom
  • Paul Brennan, Genetic Epidemiology Group, Section of Genetics, International Agency for Research on Cancer (IARC), Lyon, France., France
  • Adam S Butterworth, Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., United Kingdom
  • Elio Riboli, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., United Kingdom

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.

Original languageEnglish
Article number934
JournalThe BMJ
Volume361
Pages (from-to)k934
Number of pages9
ISSN0959-8146
DOIs
Publication statusPublished - 29 May 2018

    Research areas

  • CANCER, CARDIOVASCULAR-DISEASE, CAUSE-SPECIFIC MORTALITY, CONSUMPTION, INDIVIDUAL-PARTICIPANT DATA, LIFE-STYLE, METAANALYSIS, POLYPHENOLS, RISK-FACTORS, SMOKING-CESSATION

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