Moderate Alcohol Intake Associated with Lower Risk of CV Death, Events in Adults with CVD

Moderate alcohol consumption may be associated with reduced risk for cardiovascular (CV) mortality and events among patients with cardiovascular disease (CVD), suggests a meta-analysis published in BMC Medicine.

Specifically, the results showed that consuming up to 105 g of alcohol a week is associated with lower risks of both CV events and mortality among patients with CVD.

Although lifestyle and dietary habits are known to play a key role in secondary prevention of CVD, “the impact of alcohol consumption on CVD patients’ prognosis is unclear and recommendations for patients regarding upper limits of drinking vary substantially across different guidelines,” wrote researchers led by Chengyi Ding, PhD student, Research Department of Epidemiology and Public Health, University College London, UK.

To investigate the association further, researchers assessed alcohol consumption related to all-cause mortality, CV mortality, and CV events by analyzing data from 14 386 patients with a history of myocardial infarction (MI), angina, or stroke from the UK Biobank study, 2802 patients from 15 waves of the Health Survey for England (HSE) (1994-2008), and 3 waves of the Scottish Health Survey (SHeSs) (1995, 1998, and 2003). These data were augmented with findings from 12 published studies that provided data on 31 235 patients, 5095 deaths, and 1414 CV events.

During a median follow-up of 9.5 years in HSE/SHeSs and 8.7 years in the UK Biobank study, there were 1257 deaths among HSE/SHeSs participants and 1640 deaths among UK Biobank participants. Of these mortalities, 38.5% (n=631) from HSE/SHeSs and 39.1% (n=492) from the UK Biobank study were due to CV causes.

Results

Moderate alcohol consumption was associated with reduced risk for all-cause mortality peaking at 7 g per day (relative risk [RR]=0.79; 95% confidence interval [CI], 0.73-0.85), CV mortality peaking at 8 g per day (RR=0.73; 95% CI, 0.64–0.83), and CV events peaking at 6 g per day (RR=0.5; 95% CI, 0.26–0.96), relative to current nondrinkers. These results remained significant up to 62 g, 50 g, and 15 g per day, respectively.

Participants who consumed 6 g of alcohol per day had a 50% lower risk for recurrent MI, angina, or stroke, compared to nondrinkers. Those who consumed 8 g per day had a 27% lower risk for death due to MI, stroke, or angina, and those who consumed 7 g per day had a 21% lower risk for all-cause death, compared to nondrinkers.

The researchers did not observe any statistically significant increased risks with higher levels of alcohol consumption.

In the few studies that excluded former drinkers from the nondrinking reference group, there was a reduced risk for all-cause mortality, CV mortality, and CV events among light-to-moderate drinkers, according to the study.

Researchers cautioned, however, that their findings may have overestimated the decreased risk for recurrent MI, angina, stroke, and mortality for moderate drinkers with CVD because of the under-representation of heavy drinkers and categorization of former drinkers who may have stopped drinking.

“Our findings suggest that people with cardiovascular disease may not need to stop drinking in order to prevent additional heart attacks, strokes or angina, but that they may wish to consider lowering their weekly alcohol intake,” Ding said in a press release. “As alcohol consumption is associated with an increased risk of developing other illnesses, those with cardiovascular disease who do not drink should not be encouraged to take up drinking.”

Reference: 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 Med. 2021;19:167.