Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data

O'Neill, D., Britton, A., Hannah, M. K. , Goldberg, M., Kuh, D., Khaw, K. T. and Bell, S. (2018) Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. BMC Medicine, 16, 124. (doi: 10.1186/s12916-018-1123-6) (PMID:30131059) (PMCID:PMC6103865)

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Background: Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD. Methods: Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants’ intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics. Results: Compared to consistently moderate drinkers (males: 1–168 g ethanol/week; females: 1–112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02–1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13–1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21–1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors. Conclusions: Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake. Trial registration:, NCT03133689.

Item Type:Articles
Additional Information:This work has been undertaken as part of the Alcohol Life-course Project (, which is funded by the UK Medical Research Council/Alcohol Research UK (MR/M006638/1) and the European Research Council (ERC-StG-2012-309337_AlcoholLifecourse). EPIC-N is supported by programme grants from the UK Medical Research Council (G0401527 and G1000143) and Cancer Research United Kingdom (C864/A8257) with additional support from the Stroke Association, British Heart Foundation, Research Into Ageing and the Academy of Medical Science. GAZEL was partly supported by Agence Nationale De La Recherché (ANR-08-BLAN-0028-01), Agence Française de Sécurité Sanitaire de l’Environnement et du Travail (AFSSET-EST08–35), Electricité de France-Gaz de France and the TGIR Cohortes Santé 2008 Program. NSHD is supported by the UK Medical Research Council (MR_UC_12019/01). Twenty-07 is funded by the UK Medical Research Council (MC_A540_53462 and MC_UU_12017/13). WII is supported by the UK Medical Research Council (MR/K013351/1 and G0902037), the British Heart Foundation (RG/13/2/30098) and the US National Institutes of Health (R01HL36310 and R01AG013196).
Glasgow Author(s) Enlighten ID:Hannah, Mrs Mary-Kate
Authors: O'Neill, D., Britton, A., Hannah, M. K., Goldberg, M., Kuh, D., Khaw, K. T., and Bell, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:BMC Medicine
Publisher:BioMed Central
ISSN (Online):1741-7015
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in BMC Medicine 16:124
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU