Jinhui Zhao1, Tim Stockwell1,2,3, Audra Roemer1,2, Timothy Naimi4, Tanya Chikritzhs3,5. 1. Centre for Addictions Research of BC, University of Victoria, Victoria, British Columbia, Canada. 2. Department of Psychology, University of Victoria, British Columbia, Canada. 3. National Drug Research Institute, Curtin University, Perth, Australia. 4. Boston University Schools of Medicine and Public Health, Boston, Massachusetts. 5. Institute for Scientific Analysis, San Francisco, California.
Abstract
OBJECTIVE: Previous meta-analyses estimate that low-volume alcohol consumption protects against coronary heart disease (CHD). Potential errors in studies include systematic misclassification of drinkers as abstainers, inadequate measurement, and selection bias across the life course. METHOD: Prospective studies of alcohol consumption and CHD mortality were identified in scholarly databases and reference lists. Studies were coded for potential abstainer biases and other study characteristics. The alcohol-CHD risk relationship was estimated in mixed models with controls for potential biases. Stratified analyses were performed based on variables identified as potential effect modifiers. RESULTS: Fully adjusted meta-analysis of all 45 studies found significantly reduced CHD mortality for current low-volume drinkers (relative risk [RR] = 0.80, 95% CI [0.69, 0.93]) and all current drinkers (RR = 0.88, 95% CI [0.78, 0.99]). There was evidence of effect modification by cohort age, gender, ethnicity, and heart health at baseline. In stratified analyses, low-volume consumption was not significantly protective for cohorts ages 55 years or younger at baseline (RR = 0.95, 95% CI [0.75, 1.21]), for studies controlling for heart health (RR = 0.87, 95% CI [0.71, 1.06]), or for higher quality studies (RR = 0.86, 95% CI [0.68, 1.09]). In studies in which the mean age was 55 years or younger at baseline, there were significantly increased RRs for both former (RR = 1.45, 95% CI [1.08, 1.95]) and occasional drinkers (RR = 1.44, 95% CI [1.09, 1.89]) compared with abstainers. CONCLUSIONS: Pooled analysis of all identified studies suggested an association between alcohol use and reduced CHD risk. However, this association was not observed in studies of those age 55 years or younger at baseline, in higher quality studies, or in studies that controlled for heart health. The appearance of cardio-protection among older people may reflect systematic selection biases that accumulate over the life course.
OBJECTIVE: Previous meta-analyses estimate that low-volume alcohol consumption protects against coronary heart disease (CHD). Potential errors in studies include systematic misclassification of drinkers as abstainers, inadequate measurement, and selection bias across the life course. METHOD: Prospective studies of alcohol consumption and CHD mortality were identified in scholarly databases and reference lists. Studies were coded for potential abstainer biases and other study characteristics. The alcohol-CHD risk relationship was estimated in mixed models with controls for potential biases. Stratified analyses were performed based on variables identified as potential effect modifiers. RESULTS: Fully adjusted meta-analysis of all 45 studies found significantly reduced CHD mortality for current low-volume drinkers (relative risk [RR] = 0.80, 95% CI [0.69, 0.93]) and all current drinkers (RR = 0.88, 95% CI [0.78, 0.99]). There was evidence of effect modification by cohort age, gender, ethnicity, and heart health at baseline. In stratified analyses, low-volume consumption was not significantly protective for cohorts ages 55 years or younger at baseline (RR = 0.95, 95% CI [0.75, 1.21]), for studies controlling for heart health (RR = 0.87, 95% CI [0.71, 1.06]), or for higher quality studies (RR = 0.86, 95% CI [0.68, 1.09]). In studies in which the mean age was 55 years or younger at baseline, there were significantly increased RRs for both former (RR = 1.45, 95% CI [1.08, 1.95]) and occasional drinkers (RR = 1.44, 95% CI [1.09, 1.89]) compared with abstainers. CONCLUSIONS: Pooled analysis of all identified studies suggested an association between alcohol use and reduced CHD risk. However, this association was not observed in studies of those age 55 years or younger at baseline, in higher quality studies, or in studies that controlled for heart health. The appearance of cardio-protection among older people may reflect systematic selection biases that accumulate over the life course.
Authors: Mark J Pletcher; Paul Varosy; Catarina I Kiefe; Cora E Lewis; Stephen Sidney; Stephen B Hulley Journal: Am J Epidemiol Date: 2005-03-01 Impact factor: 4.897
Authors: Markus Juonala; Jorma S A Viikari; Mika Kähönen; Tomi Laitinen; Leena Taittonen; Britt-Marie Loo; Antti Jula; Jukka Marniemi; Leena Räsänen; Tapani Rönnemaa; Olli T Raitakari Journal: Atherosclerosis Date: 2008-11-30 Impact factor: 5.162
Authors: Tim Stockwell; Tanya Chikritzhs; Alan Bostrom; Kaye Fillmore; William Kerr; Jürgen Rehm; Ben Taylor Journal: J Stud Alcohol Drugs Date: 2007-05 Impact factor: 2.582
Authors: Yousef Tizabi; Bruk Getachew; Clifford L Ferguson; Antonei B Csoka; Karl M Thompson; Alejandra Gomez-Paz; Jana Ruda-Kucerova; Robert E Taylor Journal: Neurotox Res Date: 2018-01-04 Impact factor: 3.911
Authors: Camillia K Lui; William C Kerr; Libo Li; Nina Mulia; Yu Ye; Edwina Williams; Thomas K Greenfield; E Anne Lown Journal: Am J Prev Med Date: 2020-01-09 Impact factor: 5.043
Authors: Joshua F Baker; Bryant R England; Ted R Mikuls; Jesse Y Hsu; Michael D George; Sofia Pedro; Harlan Sayles; Kaleb Michaud Journal: Arthritis Care Res (Hoboken) Date: 2020-02-12 Impact factor: 4.794
Authors: Parag A Chevli; Krupal J Hari; Alka M Kanaya; Sameera A Talegawkar; Belinda L Needham; David Herrington Journal: Alcohol Clin Exp Res Date: 2020-08-20 Impact factor: 3.455