Abstract
BackgroundAlcohol consumption is a major global risk factor for mortality and morbidity. Much discussion has revolved around the diverse findings on the complex relationship between alcohol consumption and the leading cause of death and disability, ischemic heart disease (IHD).MethodsWe conducted a systematic search of the literature up to August 2014 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify meta-analyses and observational studies examining the relationship between alcohol drinking, drinking patterns, and IHD risk, in comparison to lifetime abstainers. In a narrative review we have summarized the many meta-analyses published in the last 10 years, discussing the role of confounding and experimental evidence. We also conducted meta-analyses examining episodic heavy drinking among on average moderate drinkers.ResultsThe narrative review showed that the use of current abstainers as the reference group leads to systematic bias. With regard to average alcohol consumption in relation to lifetime abstainers, the relationship is clearly J-shaped, supported by short-term experimental evidence and similar associations within strata of potential confounders, except among smokers. Women experience slightly stronger beneficial associations and also a quicker upturn to a detrimental effect at lower levels of average alcohol consumption compared to men. There was no evidence that chronic or episodic heavy drinking confers a beneficial effect on IHD risk. People with alcohol use disorder have an elevated risk of IHD (1.5- to 2-fold). Results from our quantitative meta-analysis showed that drinkers with average intake of <30 g/day and no episodic heavy drinking had the lowest IHD risk (relative risk = 0.64, 95% confidence interval 0.53 to 0.71). Drinkers with episodic heavy drinking occasions had a risk similar to lifetime abstainers (relative risk = 1.12, 95% confidence interval 0.91 to 1.37).ConclusionsEpidemiological evidence for a beneficial effect of low alcohol consumption without heavy drinking episodes is strong, corroborated by experimental evidence. However, episodic and chronic heavy drinking do not provide any beneficial effect on IHD. Thus, average alcohol consumption is not sufficient to describe the risk relation between alcohol consumption and IHD. Alcohol policy should try to reduce heavy drinking patterns.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0182-6) contains supplementary material, which is available to authorized users.
Highlights
Alcohol consumption is a major global risk factor for mortality and morbidity
The objective of this review is to examine the evidence available to define the relationship between alcohol consumption and ischemic heart disease (IHD) based mainly on systematic reviews and meta-analyses, with a focus on the reference group; the influence of drinking pattern; and the influence of several other important risk factors for IHD, such as age, smoking status, physical activity, and body mass index (BMI), all of which might confound risk estimates for alcohol
Using articles reviewed in these two searches, we examined the role of the reference group, average alcohol consumption, drinking patterns, confounders, and experimental evidence on the alcohol-IHD relationship in a narrative review, and conducted a quantitative analysis on drinking patterns among on average moderate alcohol drinkers in relation to lifetime abstention
Summary
Alcohol consumption is a major global risk factor for mortality and morbidity. Much discussion has revolved around the diverse findings on the complex relationship between alcohol consumption and the leading cause of death and disability, ischemic heart disease (IHD). Ischemic heart disease (IHD) is the leading cause of death and disease burden in the US [1], Europe [2], and globally [3,4], and alcohol consumption is one of the leading risk factors for mortality and morbidity [5,6]. Most meta-analyses of epidemiological data have shown a mix between a beneficial and detrimental association from alcohol consumption on IHD that depends on the level of average consumption. This relationship is most often described as curvilinear, or ‘J-shaped’ [15,16], and sometimes as a flattened-out inverse association [15,17,18]. The objective of this review is to examine the evidence available to define the relationship between alcohol consumption and IHD based mainly on systematic reviews and meta-analyses, with a focus on the reference group (that is, the use of lifetime abstainers and not current abstainers as the reference group because of the ‘sick-quitter’ effect [25]); the influence of drinking pattern (in particular episodic heavy drinking among on average moderate drinkers [26]); and the influence of several other important risk factors for IHD, such as age, smoking status, physical activity, and body mass index (BMI), all of which might confound risk estimates for alcohol
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