RT Journal Article
T1 Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies.
A1 Wood, Angela M
A1 Kaptoge, Stephen
A1 Butterworth, Adam S
A1 Willeit, Peter
A1 Warnakula, Samantha
A1 Bolton, Thomas
A1 Paige, Ellie
A1 Paul, Dirk S
A1 Sweeting, Michael
A1 Burgess, Stephen
A1 Bell, Steven
A1 Astle, William
A1 Stevens, David
A1 Koulman, Albert
A1 Selmer, Randi M
A1 Verschuren, W M Monique
A1 Sato, Shinichi
A1 Njølstad, Inger
A1 Woodward, Mark
A1 Salomaa, Veikko
A1 Nordestgaard, Børge G
A1 Yeap, Bu B
A1 Fletcher, Astrid
A1 Melander, Olle
A1 Kuller, Lewis H
A1 Balkau, Beverley
A1 Marmot, Michael
A1 Koenig, Wolfgang
A1 Casiglia, Edoardo
A1 Cooper, Cyrus
A1 Arndt, Volker
A1 Franco, Oscar H
A1 Wennberg, Patrik
A1 Gallacher, John
A1 de la Cámara, Agustín Gómez
A1 Völzke, Henry
A1 Dahm, Christina C
A1 Dale, Caroline E
A1 Bergmann, Manuela M
A1 Crespo, Carlos J
A1 van der Schouw, Yvonne T
A1 Kaaks, Rudolf
A1 Simons, Leon A
A1 Lagiou, Pagona
A1 Schoufour, Josje D
A1 Boer, Jolanda M A
A1 Key, Timothy J
A1 Rodriguez, Beatriz
A1 Moreno-Iribas, Conchi
A1 Davidson, Karina W
A1 Taylor, James O
A1 Sacerdote, Carlotta
A1 Wallace, Robert B
A1 Quiros, J Ramon
A1 Tumino, Rosario
A1 Blazer, Dan G
A1 Linneberg, Allan
A1 Daimon, Makoto
A1 Panico, Salvatore
A1 Howard, Barbara
A1 Skeie, Guri
A1 Strandberg, Timo
A1 Weiderpass, Elisabete
A1 Nietert, Paul J
A1 Psaty, Bruce M
A1 Kromhout, Daan
A1 Salamanca-Fernandez, Elena
A1 Kiechl, Stefan
A1 Krumholz, Harlan M
A1 Grioni, Sara
A1 Palli, Domenico
A1 Huerta, José M
A1 Price, Jackie
A1 Sundström, Johan
A1 Arriola, Larraitz
A1 Arima, Hisatomi
A1 Travis, Ruth C
A1 Panagiotakos, Demosthenes B
A1 Karakatsani, Anna
A1 Trichopoulou, Antonia
A1 Kühn, Tilman
A1 Grobbee, Diederick E
A1 Barrett-Connor, Elizabeth
A1 van Schoor, Natasja
A1 Boeing, Heiner
A1 Overvad, Kim
A1 Kauhanen, Jussi
A1 Wareham, Nick
A1 Langenberg, Claudia
A1 Forouhi, Nita
A1 Wennberg, Maria
A1 Després, Jean-Pierre
A1 Cushman, Mary
A1 Cooper, Jackie A
A1 Rodriguez, Carlos J
A1 Sakurai, Masaru
A1 Shaw, Jonathan E
A1 Knuiman, Matthew
A1 Voortman, Trudy
A1 Meisinger, Christa
A1 Tjønneland, Anne
A1 Brenner, Hermann
A1 Palmieri, Luigi
A1 Dallongeville, Jean
A1 Brunner, Eric J
A1 Assmann, Gerd
A1 Trevisan, Maurizio
A1 Gillum, Richard F
A1 Ford, Ian
A1 Sattar, Naveed
A1 Lazo, Mariana
A1 Thompson, Simon G
A1 Ferrari, Pietro
A1 Leon, David A
A1 Smith, George Davey
A1 Peto, Richard
A1 Jackson, Rod
A1 Banks, Emily
A1 Di Angelantonio, Emanuele
A1 Danesh, John
A1 Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group, 
AB Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies. In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
YR 2018
FD 2018
LK http://hdl.handle.net/10668/12375
UL http://hdl.handle.net/10668/12375
LA en
DS RISalud
RD Apr 9, 2025