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

Abstract

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

ClinicalTrials.gov, NCT03133689 .

Links

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  • Authors+Show Affiliations

    ,

    CLOSER, Department of Social Science, Institute of Education, University College London, London, UK. d.oneill@ucl.ac.uk.

    ,

    Research Department of Epidemiology and Public Health, University College London, London, UK.

    ,

    MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

    ,

    Inserm UMS 011, Villejuif, France and Paris Descartes University, Villejuif, France.

    ,

    Research Department of Epidemiology and Public Health, University College London, London, UK. UK MRC Unit for Lifelong Health & Ageing at UCL, London, UK.

    ,

    Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.

    Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

    Source

    BMC medicine 16:1 2018 08 22 pg 124

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Alcohol Drinking
    Cohort Studies
    Coronary Disease
    Disease Progression
    Female
    France
    Humans
    Incidence
    Longitudinal Studies
    Male
    Middle Aged
    Myocardial Infarction
    Risk Factors
    United Kingdom

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    30131059

    Citation

    O'Neill, Dara, et al. "Association of Longitudinal Alcohol Consumption Trajectories With Coronary Heart Disease: a Meta-analysis of Six Cohort Studies Using Individual Participant Data." BMC Medicine, vol. 16, no. 1, 2018, p. 124.
    O'Neill D, Britton A, Hannah MK, et al. Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. BMC Med. 2018;16(1):124.
    O'Neill, D., Britton, A., Hannah, M. K., Goldberg, M., Kuh, D., Khaw, K. T., & 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(1), p. 124. doi:10.1186/s12916-018-1123-6.
    O'Neill D, et al. Association of Longitudinal Alcohol Consumption Trajectories With Coronary Heart Disease: a Meta-analysis of Six Cohort Studies Using Individual Participant Data. BMC Med. 2018 08 22;16(1):124. PubMed PMID: 30131059.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. AU - O'Neill,Dara, AU - Britton,Annie, AU - Hannah,Mary K, AU - Goldberg,Marcel, AU - Kuh,Diana, AU - Khaw,Kay Tee, AU - Bell,Steven, Y1 - 2018/08/22/ PY - 2018/03/16/received PY - 2018/07/10/accepted PY - 2018/8/23/entrez PY - 2018/8/23/pubmed PY - 2018/10/26/medline KW - Alcohol KW - Coronary heart disease KW - IPD meta-analysis KW - Longitudinal design SP - 124 EP - 124 JF - BMC medicine JO - BMC Med VL - 16 IS - 1 N2 - 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: ClinicalTrials.gov, NCT03133689 . SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/30131059/Association_of_longitudinal_alcohol_consumption_trajectories_with_coronary_heart_disease:_a_meta_analysis_of_six_cohort_studies_using_individual_participant_data_ L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1123-6 DB - PRIME DP - Unbound Medicine ER -