Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease

Light-to-moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals. However, it is unclear whether this association is also present in those with disease. A study examined the association between alcohol consumption and prognosis in individuals with pre-existing cardiovascular disease (CVD). A series of meta-analyses of new findings from three large-scale cohorts and existing published studies were conducted.
Alcohol consumption was assessed in relation to all-cause mortality, cardiovascular mortality, and subsequent cardiovascular events via de novo analyses of 14,386 patients with a previous myocardial infarction, angina, or stroke in the UK Biobank Study (median follow-up 8.7 years), involving 1,640 deaths and 2,950 subsequent events, and 2,802 patients and ,1257 deaths in 15 waves of the Health Survey for England 1994-2008 and three waves of the Scottish Health Survey 1995, 1998, and 2003 (median follow-up 9.5 years, IQR 5.7-13.0). This was augmented with findings from 12 published studies identified through a systematic review, providing data on 31,235 patients, 5,095 deaths, and 1,414 subsequent events.
The best-fitting dose-response association between alcohol and each outcome in the combined sample of 48,423 patients, were modelled adjusting at least for age, sex, and smoking status.
Alcohol consumption was associated with all assessed outcomes in a J-shaped manner relative to current non-drinkers, with a risk reduction that peaked at 7 g/day (relative risk 0.79, 95% confidence interval 0.73-0.85) for all-cause mortality, 8 g/day (0.73, 0.64-0.83) for cardiovascular mortality and 6 g/day (0.50, 0.26-0.96) for cardiovascular events, and remained significant up to 62, 50, and 15 g/day, respectively. No statistically significant elevated risks were found at higher levels of drinking. In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated.
For secondary prevention of CVD, current drinkers may not need to stop drinking. However, they should be informed that the lowest risk of mortality and having another cardiovascular event is likely to be associated with lower levels of drinking, i.e., up to approximately 105g (or equivalent to 13 UK units) a week.
Source: Ding C; O’Neill D; Bell S; Stamatakis E; Britton A, “Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women”, BMC Medicine, Vol 19, Art No 167, 2021, 14pp.
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