Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study

Cristian Ricci, Angela Wood, David Muller, Marc J Gunter, Antonio Agudo, Heiner Boeing, Yvonne T van der Schouw, Samantha Warnakula, Calogero Saieva, Annemieke Spijkerman, Ivonne Sluijs, Anne Tjønneland, Cecilie Kyrø, Elisabete Weiderpass, Tilman Kühn, Rudolf Kaaks, Maria-Jose Sánchez, Salvatore Panico, Claudia Agnoli, Domenico PalliRosario Tumino, Gunnar Engström, Olle Melander, Fabrice Bonnet, Jolanda M A Boer, Timothy J Key, Ruth C Travis, Kim Overvad, W M Monique Verschuren, J Ramón Quirós, Antonia Trichopoulou, Eleni-Maria Papatesta, Eleni Peppa, Conchi Moreno Iribas, Diana Gavrila, Ann-Sofie Forslund, Jan-Håkan Jansson, Giuseppe Matullo, Larraitz Arriola, Heinz Freisling, Camille Lassale, Ioanna Tzoulaki, Stephen J Sharp, Nita G Forouhi, Claudia Langenberg, Rodolfo Saracci, Michael Sweeting, Paul Brennan, Adam S Butterworth, Elio Riboli, Nick J Wareham, John Danesh, Pietro Ferrari

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)


OBJECTIVE: To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke.

DESIGN: Multicentre case-cohort study.

SETTING: A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries.

PARTICIPANTS: 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison.

MAIN OUTCOME MEASURES: Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke).

RESULTS: There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events.

CONCLUSIONS: Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption.

Original languageEnglish
Pages (from-to)k934
JournalBMJ (Clinical research ed.)
Publication statusPublished - 29 May 2018
Externally publishedYes

Bibliographical note

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to


  • Alcohol Drinking/adverse effects
  • Body Mass Index
  • Cause of Death
  • Coronary Artery Disease/classification
  • Dose-Response Relationship, Drug
  • Endpoint Determination
  • Europe
  • Exercise
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Reduction Behavior
  • Smoking/adverse effects
  • Stroke/classification
  • Time Factors


Dive into the research topics of 'Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study'. Together they form a unique fingerprint.

Cite this