Your browser has javascript turned off or blocked. This will lead to some parts of our website to not work properly or at all. Turn on javascript for best performance.

The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here: https://www.microsoft.com/en-us/microsoft-365/windows/end-of-ie-support).

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

Default user image.

Olle Melander

Principal investigator

Default user image.

Risk thresholds for alcohol consumption : combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

Author

  • Angela M. Wood
  • Stephen Kaptoge
  • Adam Butterworth
  • Peter Willeit
  • Samantha Warnakula
  • Thomas Bolton
  • Ellie Paige
  • Dirk S. Paul
  • Michael Sweeting
  • Stephen Burgess
  • Steven Bell
  • William Astle
  • David Stevens
  • Albert Koulman
  • Randi M. Selmer
  • W. M.Monique Verschuren
  • Shinichi Sato
  • Inger Njølstad
  • Mark Woodward
  • Veikko Salomaa
  • Børge G. Nordestgaard
  • Bu B. Yeap
  • Astrid Fletcher
  • Olle Melander
  • Lewis H. Kuller
  • Beverley Balkau
  • Michael Marmot
  • Wolfgang Koenig
  • Edoardo Casiglia
  • Cyrus Cooper
  • Volker Arndt
  • Oscar H. Franco
  • Patrik Wennberg
  • John Gallacher
  • Agustín Gómez de la Cámara
  • Henry Völzke
  • Christina C. Dahm
  • Caroline E. Dale
  • Manuela Bergmann
  • Carlos Crespo
  • Yvonne T. van der Schouw
  • Rudolf Kaaks
  • Leon A. Simons
  • Pagona Lagiou
  • Josje D. Schoufour
  • Jolanda M.A. Boer
  • Timothy J. Key
  • Beatriz Rodriguez
  • Conchi Moreno-Iribas
  • Karina W. Davidson

Summary, in English

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.

Department/s

  • Department of Clinical Sciences, Malmö
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence in Diabetes Research in Sweden

Publishing year

2018-04-14

Language

English

Pages

1513-1523

Publication/Series

The Lancet

Volume

391

Issue

10129

Document type

Journal article

Publisher

Elsevier

Topic

  • Environmental Health and Occupational Health

Status

Published

ISBN/ISSN/Other

  • ISSN: 0140-6736