ABSTRACT

Objective To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke.

Design Multicentre case-cohort study.

Setting A study of cardiovascular disease (CVD) aetiology (EPIC-CVD) within the European Prospective Investigation into Cancer and nutrition cohort from 8 European countries.

Participants A case-cohort study of 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison.

Main outcome measure Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic).

Results There were 9307 non-fatal CHD, 1699 fatal CHD, 5855 non-fatal stroke and 733 fatal stroke events. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J-shaped association between baseline alcohol intake and risk of fatal CHD (hazard ratios=0.83 [95% confidence interval 0.70 to 0.98], 0.65 [0.53 to 0.81], and 0.82 [0.65 to 1.03] for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (95% confidence interval 1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries we studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events.

Conclusions Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with risk of different stroke subtypes, highlighting the opposing associations of alcohol intake with different cardiovascular disease types and strengthening the evidence for policies to reduce alcohol consumption.