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Association of Alcohol Consumption With Selected Cardiovascular Disease Outcomes: A Systematic Review and Meta-Analysis

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Review

Association of Alcohol Consumption With Selected Cardiovascular Disease Outcomes: A Systematic Review and Meta-Analysis

Paul E Ronksley et al. BMJ.

Abstract

Objective: To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes.

Design: Systematic review and meta-analysis.

Data sources: A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings. Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke. Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis.

Results: The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1-2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).

Conclusions: Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

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: support from the Robert Wood Johnson Foundation, the Substance Abuse and Mental Health Services, and the Administration Center for Substance Abuse Treatment (as detailed above) for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Details of study selection for review
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Fig 2 Forest plot of mortality from cardiovascular disease associated with alcohol consumption
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Fig 3 Forest plot of incident coronary heart disease associated with alcohol consumption
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Fig 4 Forest plot of mortality from coronary heart disease associated with alcohol consumption
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Fig 5 Forest plot of incident stroke associated with alcohol consumption
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Fig 6 Forest plot of mortality from stroke associated with alcohol consumption
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Fig 7 Forest plot of mortality from all causes associated with alcohol consumption

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