Alcohol Consumption and All-Cause, CV, and Cancer-Related Mortality

Study Questions:

What is the association between alcohol consumption and risk of mortality from all causes, cancer, and cardiovascular disease (CVD) in US adults?

Methods:

Data were obtained by linking 13 National Health Interview Surveys (1997-2009) to the National Death Index records through December 31, 2011. A total of 333,247 participants ages ≥18 years were included. One drink was considered 1.5 oz of 80 proof spirits, 5 oz wine, or 12 oz beer with 5% alcohol. Self-reported alcohol consumption patterns were categorized into six groups: lifetime abstainers, lifetime infrequent drinkers, former drinkers, and current light <3 drinks/week, moderate >3 and ≤14 per week for men and ≤7 for women, or heavy drinkers >14/week for men and >7 for women. Secondary exposure included binge-drinking status (five or more drinks in 1 or more days a week). The main outcome was all-cause, cancer, or CVD mortality.

Results:

Approximately 78% of the subjects were <60 years of age; 60% of all subjects were light (40%), moderate (15%), or heavy drinkers (5%). After a median follow-up of 8.2 years (2.7 million person-years), 34,754 participants died from all causes (including 8,947 CVD deaths and 8,427 cancer deaths). Compared with lifetime abstainers, those who were light or moderate alcohol consumers were at reduced risk of mortality for all causes (light: hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.76-0.82; moderate: HR, 0.78; 95% CI, 0.74-0.82), and CVD (light: HR, 0.74; 95% CI, 0.69-0.80; moderate: HR, 0.71; 95% CI, 0.64-0.78), respectively. In contrast, there was a significantly increased risk of all-cause mortality (HR, 1.11; 95% CI, 1.04-1.19) and cancer (HR, 1.27; 95% CI, 1.13-1.42) in adults with heavy alcohol consumption. Binge drinking ≥1 day/week was also associated with increased risk of mortality for all causes (HR, 1.13; 95% CI, 1.04-1.23) and cancer (HR, 1.22; 95% CI, 1.05-1.41).

Conclusions:

Light and moderate alcohol intake might have a protective effect on all-cause and CVD-specific mortality in US adults. Heavy or binge drinking was associated with increased risk of all-cause and cancer-specific mortality.

Perspective:

The findings are consistent with the conclusions of the 2015 US Dietary Guidelines for Americans and the American Heart Association. While suggesting light to moderate alcohol intake may be beneficial, it is important to emphasize the risks of binge and heavy drinking to all age groups. Of note, while excessive alcohol is a major risk factor for hypertension, light to moderate alcohol may reduce CV events in persons with coronary heart disease and controlled hypertension.


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