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 Palli; Rosario 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

doi:10.1136/bmj.k934

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 journal › Article › peer-review

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Abstract

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 language	English
Pages (from-to)	k934
Journal	BMJ (Clinical research ed.)
Volume	361
DOIs	https://doi.org/10.1136/bmj.k934
Publication status	Published - 29 May 2018
Externally published	Yes

Bibliographical note

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Ricci, C., Wood, A., Muller, D., Gunter, M. J., Agudo, A., Boeing, H., van der Schouw, Y. T., Warnakula, S., Saieva, C., Spijkerman, A., Sluijs, I., Tjønneland, A., Kyrø, C., Weiderpass, E., Kühn, T., Kaaks, R., Sánchez, M.-J., Panico, S., Agnoli, C., ... Ferrari, P. (2018). Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study. BMJ (Clinical research ed.), 361, k934. https://doi.org/10.1136/bmj.k934

@article{8df333afba204cc39d6d260a394a2149,

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

abstract = "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.",

keywords = "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",

author = "Cristian Ricci and Angela Wood and David Muller and Gunter, {Marc J} and Antonio Agudo and Heiner Boeing and {van der Schouw}, {Yvonne T} and Samantha Warnakula and Calogero Saieva and Annemieke Spijkerman and Ivonne Sluijs and Anne Tj{\o}nneland and Cecilie Kyr{\o} and Elisabete Weiderpass and Tilman K{\"u}hn and Rudolf Kaaks and Maria-Jose S{\'a}nchez and Salvatore Panico and Claudia Agnoli and Domenico Palli and Rosario Tumino and Gunnar Engstr{\"o}m and Olle Melander and Fabrice Bonnet and Boer, {Jolanda M A} and Key, {Timothy J} and Travis, {Ruth C} and Kim Overvad and Verschuren, {W M Monique} and Quir{\'o}s, {J Ram{\'o}n} and Antonia Trichopoulou and Eleni-Maria Papatesta and Eleni Peppa and Iribas, {Conchi Moreno} and Diana Gavrila and Ann-Sofie Forslund and Jan-H{\aa}kan Jansson and Giuseppe Matullo and Larraitz Arriola and Heinz Freisling and Camille Lassale and Ioanna Tzoulaki and Sharp, {Stephen J} and Forouhi, {Nita G} and Claudia Langenberg and Rodolfo Saracci and Michael Sweeting and Paul Brennan and Butterworth, {Adam S} and Elio Riboli and Wareham, {Nick J} and John Danesh and Pietro Ferrari",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2018",

month = may,

day = "29",

doi = "10.1136/bmj.k934",

language = "English",

volume = "361",

pages = "k934",

journal = "BMJ (Clinical research ed.)",

issn = "0959-8138",

publisher = "British Medical Association",

}

Ricci, C, Wood, A, Muller, D, Gunter, MJ, Agudo, A, Boeing, H, van der Schouw, YT, Warnakula, S, Saieva, C, Spijkerman, A, Sluijs, I, Tjønneland, A, Kyrø, C, Weiderpass, E, Kühn, T, Kaaks, R, Sánchez, M-J, Panico, S, Agnoli, C, Palli, D, Tumino, R, Engström, G, Melander, O, Bonnet, F, Boer, JMA, Key, TJ, Travis, RC, Overvad, K, Verschuren, WMM, Quirós, JR, Trichopoulou, A, Papatesta, E-M, Peppa, E, Iribas, CM, Gavrila, D, Forslund, A-S, Jansson, J-H, Matullo, G, Arriola, L, Freisling, H, Lassale, C, Tzoulaki, I, Sharp, SJ, Forouhi, NG, Langenberg, C, Saracci, R, Sweeting, M, Brennan, P, Butterworth, AS, Riboli, E, Wareham, NJ, Danesh, J & Ferrari, P 2018, 'Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study', BMJ (Clinical research ed.), vol. 361, pp. k934. https://doi.org/10.1136/bmj.k934

TY - JOUR

T1 - Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study

AU - Ricci, Cristian

AU - Wood, Angela

AU - Muller, David

AU - Gunter, Marc J

AU - Agudo, Antonio

AU - Boeing, Heiner

AU - van der Schouw, Yvonne T

AU - Warnakula, Samantha

AU - Saieva, Calogero

AU - Spijkerman, Annemieke

AU - Sluijs, Ivonne

AU - Tjønneland, Anne

AU - Kyrø, Cecilie

AU - Weiderpass, Elisabete

AU - Kühn, Tilman

AU - Kaaks, Rudolf

AU - Sánchez, Maria-Jose

AU - Panico, Salvatore

AU - Agnoli, Claudia

AU - Palli, Domenico

AU - Tumino, Rosario

AU - Engström, Gunnar

AU - Melander, Olle

AU - Bonnet, Fabrice

AU - Boer, Jolanda M A

AU - Key, Timothy J

AU - Travis, Ruth C

AU - Overvad, Kim

AU - Verschuren, W M Monique

AU - Quirós, J Ramón

AU - Trichopoulou, Antonia

AU - Papatesta, Eleni-Maria

AU - Peppa, Eleni

AU - Iribas, Conchi Moreno

AU - Gavrila, Diana

AU - Forslund, Ann-Sofie

AU - Jansson, Jan-Håkan

AU - Matullo, Giuseppe

AU - Arriola, Larraitz

AU - Freisling, Heinz

AU - Lassale, Camille

AU - Tzoulaki, Ioanna

AU - Sharp, Stephen J

AU - Forouhi, Nita G

AU - Langenberg, Claudia

AU - Saracci, Rodolfo

AU - Sweeting, Michael

AU - Brennan, Paul

AU - Butterworth, Adam S

AU - Riboli, Elio

AU - Wareham, Nick J

AU - Danesh, John

AU - Ferrari, Pietro

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2018/5/29

Y1 - 2018/5/29

N2 - 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.

AB - 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.

KW - Alcohol Drinking/adverse effects

KW - Body Mass Index

KW - Cause of Death

KW - Coronary Artery Disease/classification

KW - Dose-Response Relationship, Drug

KW - Endpoint Determination

KW - Europe

KW - Exercise

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Risk Reduction Behavior

KW - Smoking/adverse effects

KW - Stroke/classification

KW - Time Factors

U2 - 10.1136/bmj.k934

DO - 10.1136/bmj.k934

M3 - Article

C2 - 29844013

SN - 0959-8138

VL - 361

SP - k934

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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