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 869-14,247 participants) of whom 4.9% experienced an incident (fatal/non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants’ intake trajectories over approximately ten years. Time-to-onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. Individual participant data meta-analysis was employed to estimate the association with CHD onset, adjusting for demographic and clinical characteristics.

Findings Compared to consistently moderate drinkers (males: 1-168g ethanol/week; females: 1-112g ethanol/week), inconsistently moderate drinkers had significantly greater risk of incident CHD (HR=1.18, 95%CI=1.02-1.37). 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 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 effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake.