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Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

Accepted version
Peer-reviewed

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Authors

Wood, AM 
Kaptoge, stephen 
Butterworth, adam 
Paul, Dirk 
Burgess, Stephen 

Abstract

Background Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease (CVD), we studied individual-participant data on 599,912 current drinkers without prior CVD. Methods We characterised dose-response associations and calculated hazard ratios (HRs) per 100 grams/week of alcohol (12.5 units/week) across 83 prospective studies in 19 countries, adjusting at least for study/centre, age, sex, smoking, and diabetes. We recorded 40,317 deaths and 39,018 incident CVD events during 5.4 million person-years of follow-up. We corrected HRs for long-term variability in alcohol consumption using 152,640 serial alcohol assessments obtained some years apart (median interval: 5.6 years).

Findings For all-cause mortality, there was a positive and curvilinear association, with minimum risk around or below 100 grams/week. Alcohol consumption was approximately linearly associated with higher risk of: stroke (HR, 95% CI: 1.14, 1.10-1.17); coronary disease excluding myocardial infarction (1.06, 1.00-1.17); heart failure (1.09, 1.03-1.15); fatal hypertensive disease (1.24, 1.15-1.33); and fatal aortic aneurysm (1.15, 1.03-1.28). By contrast, alcohol consumption was log-linearly associated with lower risk of myocardial infarction (0.94, 0.91-0.97). Compared with current low-risk limits in US guidelines (196 grams/week for men), consumption of less than 100 grams/week could increase male life expectancy by about 1-2 years.

Interpretation Among current drinkers, the threshold for lowest risk of all-cause mortality was about 100 grams/week. For CVD subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than in current guidelines.

Description

Keywords

Alcohol Drinking, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Prospective Studies

Journal Title

The Lancet

Conference Name

Journal ISSN

0140-6736
1474-547X

Volume Title

391

Publisher

Elsevier
Sponsorship
Department of Health (via National Institute for Health Research (NIHR)) (NIHR BTRU-2014-10024)
British Heart Foundation (None)
Medical Research Council (MC_UU_12015/1)
European Commission (37197)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
Medical Research Council (MR/N003284/1)
Medical Research Council (MC_UU_12015/5)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
Medical Research Council (G0700463)
Medical Research Council (MC_UU_12012/5)
Medical Research Council (MR/L003120/1)
Medical Research Council (G0800270)
European Research Council (268834)
British Heart Foundation (None)
Medical Research Council (MC_UU_00002/7)
Medical Research Council (MR/K014811/1)
Medical Research Council (G0701619)
Wellcome Trust (204623/Z/16/Z)
British Heart Foundation (CH/12/2/29428)
Medical Research Council (MC_PC_12012)
Medical Research Council (G0700463/1)
Medical Research Council (G0800270/1)
UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.