Alcohol's CV and Cancer Risk-Balancing Act: More Evidence

August 18, 2017

WASHINGTON, DC — Adjusted analyses based on large cohorts of US adults point to reduced mortality risk—all-cause, cardiovascular, and cancer-related—at lower levels of alcohol consumption and show increased all-cause and cancer mortality risk at the highest alcohol-intake levels[1]. Cardiovascular mortality was not significantly increased at the highest-intake levels.

"Our study reemphasized the existence of a J-shaped curve in the alcohol–mortality association, supporting current findings that light to moderate drinking might be protective, especially for CVD, but heavy drinking or binge drinking has serious health consequences, including death," according to the study's authors, led by Dr Bo Xi (Shandong University, Jinan, China).

Their report, published in the August 22, 2017 issue of the Journal of the American College of Cardiology, is based on self-reported data from 333,247 participants across 13 years of the National Health Interview Survey (NHIS); the median follow-up was 8.2 years.

Adjusted Mortality Risk (95% CI) by Alcohol Consumption Status (Compared With Lifetime Abstainer) in NHIS

Mortality cause Lifetime, infrequent Former drinker Light drinker Moderate drinker Heavy drinker
All-cause 1.03 (0.99–1.07) 1.07 (1.02–1.11) 0.79 (0.76–0.82) 0.78 (0.74–0.82) 1.11 (1.04–1.19)
Cancer        1.03 (0.95–1.12) 1.14 (1.04–1.24) 0.86 (0.80–0.93) 0.87 (0.80–0.96) 1.27 (1.13–1.42)
Heart disease 1.05 (0.95–1.15) 0.99 (0.90–1.10) 0.75 (0.69–0.81) 0.71 (0.63–0.80) 0.96 (0.82–1.14)
Cerebrovascular 1.08 (0.93–1.26) 1.00 (0.82–1.20) 0.72 (0.62–0.83) 0.68 (0.56–0.82) 0.77 (0.56–1.06)
Adjusted for sex, age, race or ethnicity, education, marital status, body-mass index, physical activity, smoking, and physician-diagnosed diseases (hypertension, heart disease, stroke, cancer, and diabetes)

In subgroup analyses, light and moderate alcohol intake predicted reduced all-cause, cardiovascular, and cancer mortalities in both men and women, whereas the highest levels of alcohol intake were associated with increased all-cause and cancer mortality in men but not women, the group reported.

The authors describe aspects of their "robust analytical strategies" that set their report apart from many others describing alcohol-related mortality.

Indeed, according to an accompanying editorial[2], numerous studies have shown J-shaped or U-shaped curves for the relationship between alcohol intake and mortality risk, and the current data "appear to be largely confirmatory."

But Xi et al "have pointed out relevant drawbacks from some of the previous studies, such as 'abstainer bias' or inappropriate adjustment for confounders or different patterns of alcohol drinking," write Drs Giovanni de Gaetano and Simona Costanzo (IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy).

The current analysis, they write, "supports the conclusion that the J-shaped relationship between alcohol consumption and mortality risk cannot be dismissed and should guide the formulation of public policies on alcohol consumption."

The authors of both the report and editorial reported no relevant financial relationships.

Follow Steve Stiles on Twitter: @SteveStiles2. For more from theheart.org | Medscape Cardiology, follow us on Twitter and Facebook.

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