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Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies.
Wood, Angela M; Kaptoge, Stephen; Butterworth, Adam S; Willeit, Peter; Warnakula, Samantha; Bolton, Thomas; Paige, Ellie; Paul, Dirk S; Sweeting, Michael; Burgess, Stephen; Bell, Steven; Astle, William; Stevens, David; Koulman, Albert; Selmer, Randi M; Verschuren, W M Monique; Sato, Shinichi; Njølstad, Inger; Woodward, Mark; Salomaa, Veikko; Nordestgaard, Børge G; Yeap, Bu B; Fletcher, Astrid; Melander, Olle; Kuller, Lewis H; Balkau, Beverley; Marmot, Michael; Koenig, Wolfgang; Casiglia, Edoardo; Cooper, Cyrus; Arndt, Volker; Franco, Oscar H; Wennberg, Patrik; Gallacher, John; de la Cámara, Agustín Gómez; Völzke, Henry; Dahm, Christina C; Dale, Caroline E; Bergmann, Manuela M; Crespo, Carlos J; van der Schouw, Yvonne T; Kaaks, Rudolf; Simons, Leon A; Lagiou, Pagona; Schoufour, Josje D; Boer, Jolanda M A; Key, Timothy J; Rodriguez, Beatriz; Moreno-Iribas, Conchi; Davidson, Karina W.
Afiliação
  • Wood AM; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Electronic address: amw79@medschl.cam.ac.uk.
  • Kaptoge S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Butterworth AS; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Willeit P; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Medical University Innsbruck, Innsbruck, Austria.
  • Warnakula S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Bolton T; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Paige E; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
  • Paul DS; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Sweeting M; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Burgess S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
  • Bell S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Astle W; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Stevens D; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Koulman A; NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK.
  • Selmer RM; Norwegian Institute of Public Health, Oslo, Norway.
  • Verschuren WMM; National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
  • Sato S; Chiba Prefectural Institute of Public Health, Chiba, Japan.
  • Njølstad I; Department of Community Medicine, University of Tromsø, Tromsø, Norway.
  • Woodward M; Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
  • Salomaa V; THL-National Institute for Health and Welfare, Helsinki, Finland.
  • Nordestgaard BG; Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • Yeap BB; School of Medicine, University of Western Australia, Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia.
  • Fletcher A; London School of Hygiene & Tropical Medicine, London, UK.
  • Melander O; Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
  • Kuller LH; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
  • Balkau B; CESP INSERM UMRS 1018, Villejuif Cedex, France.
  • Marmot M; Department of Epidemiology and Public Health, University College London, London, UK.
  • Koenig W; 92 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; University of Ulm Medical Center, Ulm, Germany.
  • Casiglia E; Department of Medicine, University of Padua, Padua, Italy.
  • Cooper C; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
  • Arndt V; German Cancer Research Center (DKFZ), Heidelberg, Germany.
  • Franco OH; Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
  • Wennberg P; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
  • Gallacher J; Department of Primary Care and Public Health, Cardiff University, Cardiff, UK.
  • de la Cámara AG; 12 de Octubre Research Institute, CIBERESP, Madrid, Spain.
  • Völzke H; Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
  • Dahm CC; Department of Public Health, Aarhus University, Aarhus, Denmark.
  • Dale CE; Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK.
  • Bergmann MM; German Institute of Human Nutrition, Potsdam-Rehbrüke, Germany.
  • Crespo CJ; School of Community Health, Portland State University, Portland, OR, USA.
  • van der Schouw YT; Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
  • Kaaks R; German Cancer Research Center (DKFZ), Heidelberg, Germany.
  • Simons LA; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
  • Lagiou P; Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece; Harvard TH Chan School of Public Health, Boston, MA, USA.
  • Schoufour JD; Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
  • Boer JMA; National Institute for Public Health and the Environment, Bilthoven, Netherlands.
  • Key TJ; Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
  • Rodriguez B; Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA.
  • Moreno-Iribas C; Instituto de Salud Pública de Navarra, IdiSNA - Navarra Institute for Health Research, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain.
  • Davidson KW; Columbia University Irving Medical Center, New York, NY, USA.
Lancet ; 391(10129): 1513-1523, 2018 04 14.
Article em En | MEDLINE | ID: mdl-29676281
BACKGROUND: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. METHODS: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies. FINDINGS: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. INTERPRETATION: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Consumo de Bebidas Alcoólicas Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Consumo de Bebidas Alcoólicas Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article