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Review
. 2011 Feb 22:342:d636.
doi: 10.1136/bmj.d636.

Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies

Susan E Brien  1 , Paul E Ronksley, Barbara J Turner, Kenneth J Mukamal, William A Ghali
Affiliations
Review

Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies

Susan E Brien et al. BMJ. .

Abstract

Objective: To systematically review interventional studies of the effects of alcohol consumption on 21 biological markers associated with risk of coronary heart disease in adults without known cardiovascular disease.

Design: Systematic review and meta-analysis.

Data sources: Medline (1950 to October 2009) and Embase (1980 to October 2009) without limits.

Study selection: Two reviewers independently selected studies that examined adults without known cardiovascular disease and that compared fasting levels of specific biological markers associated with coronary heart disease after alcohol use with those after a period of no alcohol use (controls). 4690 articles were screened for eligibility, the full texts of 124 studies reviewed, and 63 relevant articles selected.

Results: Of 63 eligible studies, 44 on 13 biomarkers were meta-analysed in fixed or random effects models. Quality was assessed by sensitivity analysis of studies grouped by design. Analyses were stratified by type of beverage (wine, beer, spirits). Alcohol significantly increased levels of high density lipoprotein cholesterol (pooled mean difference 0.094 mmol/L, 95% confidence interval 0.064 to 0.123), apolipoprotein A1 (0.101 g/L, 0.073 to 0.129), and adiponectin (0.56 mg/L, 0.39 to 0.72). Alcohol showed a dose-response relation with high density lipoprotein cholesterol (test for trend P = 0.013). Alcohol decreased fibrinogen levels (-0.20 g/L, -0.29 to -0.11) but did not affect triglyceride levels. Results were similar for crossover and before and after studies, and across beverage types.

Conclusions: Favourable changes in several cardiovascular biomarkers (higher levels of high density lipoprotein cholesterol and adiponectin and lower levels of fibrinogen) provide indirect pathophysiological support for a protective effect of moderate alcohol use on coronary heart disease.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: All authors had support from a contracted operating grant from Program of Research Integrating Substance Use Information into Mainstream Healthcare (PRISM) funded by the Robert Wood Johnson Foundation project No 58529, with cofunding by the Substance Abuse and Mental Health Services and the Administration Center for Substance Abuse Treatment for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of studies through review
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Fig 2 Forest plot of meta-analysis (random effects) of effect of alcohol consumption on levels of high and low density lipoprotein cholesterol
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Fig 3 Forest plot of meta-analysis (fixed effects) of effect of alcohol consumption on levels of total cholesterol and triglycerides
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Fig 4 Forest plot of meta-analysis of effect of alcohol consumption on levels of fibrinogen and adiponectin
See this image and copyright information in PMC

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