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Angela M Wood, Stephen Kaptoge, Adam S Butterworth, Peter Willeit, Samantha Warnakula, Thomas Bolton, Ellie Paige, Dirk S Paul, Michael Sweeting, Stephen Burgess, Steven Bell, William Astle, David Stevens, Albert Koulman, Randi M Selmer, W M Monique Verschuren, Shinichi Sato, Inger Njølstad, Mark Woodward, Veikko Salomaa, Børge G Nordestgaard, Bu B Yeap, Astrid Fletcher, Olle Melander, Lewis H Kuller, Beverley Balkau, Michael Marmot, Wolfgang Koenig, Edoardo Casiglia, Cyrus Cooper, Volker Arndt, Oscar H Franco, Patrik Wennberg, John Gallacher, Agustín Gómez de la Cámara, Henry Völzke, Christina C Dahm, Caroline E Dale, Manuela M Bergmann, Carlos J Crespo, Yvonne T van der Schouw, Rudolf Kaaks, Leon A Simons, Pagona Lagiou, Josje D Schoufour, Jolanda M A Boer, Timothy J Key, Beatriz Rodriguez, Conchi Moreno-Iribas, Karina W Davidson, James O Taylor, Carlotta Sacerdote, Robert B Wallace, J Ramon Quiros, Rosario Tumino, Dan G Blazer, Allan Linneberg, Makoto Daimon, Salvatore Panico, Barbara Howard, Guri Skeie, Timo Strandberg, Elisabete Weiderpass, Paul J Nietert, Bruce M Psaty, Daan Kromhout, Elena Salamanca-Fernandez, Stefan Kiechl, Harlan M Krumholz, Sara Grioni, Domenico Palli, José M Huerta, Jackie Price, Johan Sundström, Larraitz Arriola, Hisatomi Arima, Ruth C Travis, Demosthenes B Panagiotakos, Anna Karakatsani, Antonia Trichopoulou, Tilman Kühn, Diederick E Grobbee, Elizabeth Barrett-Connor, Natasja van Schoor, Heiner Boeing, Kim Overvad, Jussi Kauhanen, Nick Wareham, Claudia Langenberg, Nita Forouhi, Maria Wennberg, Jean-Pierre Després, Mary Cushman, Jackie A Cooper, Carlos J Rodriguez, Masaru Sakurai, Jonathan E Shaw, Matthew Knuiman, Trudy Voortman, Christa Meisinger, Anne Tjønneland, Hermann Brenner, Luigi Palmieri, Jean Dallongeville, Eric J Brunner, Gerd Assmann, Maurizio Trevisan, Richard F Gillum, Ian Ford, Naveed Sattar, Mariana Lazo, Simon G Thompson, Pietro Ferrari, David A Leon, George Davey Smith, Richard Peto, Rod Jackson, Emily Banks, Emanuele Di Angelantonio, John Danesh, Angela M Wood, Stephen Kaptoge, Adam Butterworth, Peter Willeit, Samantha Warnakula, Thomas Bolton, Ellie Paige, Dirk S Paul, Michael Sweeting, Stephen Burgess, Steven Bell, William Astle, David Stevens, Albert Koulman, Randi M Selmer, Monique Verschuren, Shinichi Sato, Inger Njølstad, Mark Woodward, Salomaa Veikko, Børge G Nordestgaard, Bu B Yeap, Astrid Flecther, Olle Melander, Lewis H Kuller, Beverley Balkau, Michael Marmot, Wolfgang Koenig, Edoardo Casiglia, Cyrus Cooper, Volker Arndt, Oscar H Franco, Patrik Wennberg, John Gallacher, Agustín Gómez de la Cámara, Henry Völzke, Christina C Dahm, Caroline E Dale, Manuela Bergmann, Carlos Crespo, Yvonne T van der Schouw, Rudolf Kaaks, Leon A Simons, Pagona Lagiou, Josje D Schoufour, Jolanda M.A Boer, Timothy J Key, Beatriz Rodriguez, Conchi Moreno-Iribas, Karina W Davidson, James O Taylor, Carlotta Sacerdote, Robert B Wallace, J. Ramon Quiros, Eric B Rimm, Rosario Tumino, Dan G Blazer III, Allan Linneberg, Makoto Daimon, Salvatore Panico, Barbara Howard, Guri Skeie, Veikko Salomaa, Timo Strandberg, Elisabete Weiderpass, Paul J Nietert, Bruce M Psaty, Daan Kromhout, Elena Salamanca-Fernandez, Stefan Kiechl, Harlan M Krumholz, Sara Grioni, Domenico Palli, José M Huerta, Jackie Price, Johan Sundström, Larraitz Arriola, Hisatomi Arima, Ruth C Travis, Demosthenes B Panagiotakos, Anna Karakatsani, Antonia Trichopoulou, Tilman Kühn, Diederick E Grobbee, Elizabeth Barrett-Connor, Natasja van Schoor, Heiner Boeing, Kim Overvad, Jussi Kauhanen, Nick Wareham, Claudia Langenberg, Nita Forouhi, Maria Wennberg, Jean-Pierre Després, Mary Cushman, Jackie A Cooper, Carlos J Rodriguez, Masaru Sakurai, Jonathan E Shaw, Matthew Knuiman, Trudy Voortman, Christa Meisinger, Anne Tjønneland, Hermann Brenner, Luigi Palmieri, Jean-Pierre Dallongeville, Eric J Brunner, Gerd Assmann, Maurizio Trevisan, Richard F Gillumn, Ian Ford Ford, Naveed Sattar, Mariana Lazo, Simon Thompson, Pietro Ferrari, David A Leon, George Davey Smith, Richard Peto, Rod Jackson, Emily Banks, Emanuele Di Angelantonio, John Danesh, Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies, The Lancet, Volume 391, Issue 10129, 2018, Pages 1513-1523, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(18)30134-X

Risk thresholds for alcohol consumption : combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

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Author: Wood, Angela M.1; Kaptoge, Stephen1; Butterworth, Adam S.1;
Willeit, Peter1,2; Warnakula, Samantha1; Bolton, Thomas1; Paige, Ellie3; Paul, Dirk S.1; Sweeting, Michael1; Burgess, Stephen1,4; Bell, Steven1; Astle, William1; Stevens, David1; Koulman, Albert5; Selmer, Randi M.6; Verschuren, W. M. Monique7,8; Sato, Shinichi9; Njolstad, Inger10; Woodward, Mark11,12,13; Salomaa, Veikko14; Nordestgaard, Borge G.15,16; Yeap, Bu B.17,18,19; Fletcher, Astrid20; Melander, Olle21; Kuller, Lewis H.22; Balkau, Beverley23; Marmot, Michael24; Koenig, Wolfgang25,26; Casiglia, Edoardo27; Cooper, Cyrus28; Arndt, Volker29; Franco, Oscar H.30; Wennberg, Patrik31; Gallacher, John32; de la Camara, Agustin Gomez33; Volzke, Henry34; Dahm, Christina C.35; Dale, Caroline E.36; Bergmann, Manuela M.37; Crespo, Carlos J.38; van der Schouw, Yvonne T.8; Kaaks, Rudolf29; Simons, Leon A.39; Lagiou, Pagona40,41,42; Schoufour, Josje D.30; Boer, Jolanda M. A.7; Key, Timothy J.11; Rodriguez, Beatriz43; Moreno-Iribas, Conchi44,45; Davidson, Karina W.46; Taylor, James O.47; Sacerdote, Carlotta48; Wallace, Robert B.49; Quiros, J. Ramon50; Tumino, Rosario51; Blazer, Dan G., II52; Linneberg, Allan16; Daimon, Makoto53; Panico, Salvatore54; Howard, Barbara55; Skeie, Guri56; Strandberg, Timo57,58,59; Weiderpass, Elisabete56,60,61,62; Nietert, Paul J.63; Psaty, Bruce M.64,65,66,67; Kromhout, Daan68,69,70; Salamanca-Fernandez, Elena71,72; Kiechl, Stefan2; Krumholz, Harlan M.; Grioni, Sara73; Palli, Domenico74; Huerta, Jose M.72,75; Price, Jackie76; Sundstrom, Johan77; Arriola, Larraitz72,78; Arima, Hisatomi79,80,81; Travis, Ruth C.11; Panagiotakos, Demosthenes B.82; Karakatsani, Anna40,41; Trichopoulou, Antonia40,41; Kuhn, Tilman29; Grobbee, Diederick E.8; Barrett-Connor, Elizabeth83; van Schoor, Natasja84; Boeing, Heiner37; Overvad, Kim35,85; Kauhanen, Jussi86; Wareham, Nick87; Langenberg, Claudia87; Forouhi, Nita87; Wennberg, Maria31; Despres, Jean-Pierre88; Cushman, Mary89; Cooper, Jackie A.24; Rodriguez, Carlos J.90,91; Sakurai, Masaru92; Shaw, Jonathan E.93; Knuiman, Matthew94,95; Voortman, Trudy30; Meisinger, Christa96; Tjonneland, Anne97; Brenner, Hermann29,98; Palmieri, Luigi99; Dallongeville, Jean100; Brunner, Eric J.24; Assmann, Gerd101; Trevisan, Maurizio102; Gillum, Richard F.103; Ford, Ian104; Sattar, Naveed104; Lazo, Mariana105; Thompson, Simon G.1; Ferrari, Pietro106; Leon, David A.20; Smith, George Davey107; Peto, Richard; Jackson, Rod108; Banks, Emily3; Di Angelantonio, Emanuele1; Danesh, John1
Organizations: 1Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England.
2Med Univ Innsbruck, Innsbruck, Austria.
3Australian Natl Univ, Natl Ctr Epidemiol & Populat Hlth, Canberra, ACT, Australia.
4Univ Cambridge, Cambridge Inst Publ Hlth, MRC Biostat Unit, Cambridge, England.
5Univ Cambridge, NIHR BRC Nutr Biomarker Lab, Cambridge, England.
6Norwegian Inst Publ Hlth, Oslo, Norway.
7Natl Inst Publ Hlth & Environm, Bilthoven, Netherlands.
8Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands.
9Chiba Prefectural Inst Publ Hlth, Chiba, Japan.
10Univ Tromso, Dept Community Med, Tromso, Norway.
11Univ Oxford, Nuffield Dept Populat Hlth, Med Sci Div, Oxford, England.
12Univ Sydney, George Inst Global Hlth, Sydney, NSW, Australia.
13Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA.
14THL Natl Inst Hlth & Welf, Helsinki, Finland.
15Copenhagen Univ Hosp, Copenhagen, Denmark.
16Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark.
17Univ Western Australia, Sch Med, Perth, WA, Australia.
18Fiona Stanley Hosp, Perth, WA, Australia.
19Harry Perkins Inst Med Res, Perth, WA, Australia.
20London Sch Hyg & Trop Med, London, England.
21Lund Univ, Dept Clin Sci, Malmo, Sweden.
22Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA USA.
23INSERM, UMRS 1018, CESP, Villejuif, France.
24UCL, Dept Epidemiol & Publ Hlth, London, England.
25Tech Univ Munich, Deutsch Herzzentrum Munchen 92, DZHK German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany.
26Univ Ulm, Med Ctr, Ulm, Germany.
27Univ Padua, Dept Med, Padua, Italy.
28Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England.
29German Canc Res Ctr, Heidelberg, Germany.
30Erasmus Univ, Med Ctr, Rotterdam, Netherlands.
31Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
32Cardiff Univ, Dept Primary Care & Publ Hlth, Cardiff, S Glam, Wales.
33CIBERESP, Octubre Res Inst 12, Madrid, Spain.
34Univ Med Greifswald, Inst Community Med, Greifswald, Germany.
35Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.
36UCL, UCL Inst Hlth Informat, Farr Inst Hlth Informat Res, London, England.
37German Inst Human Nutr, Potsdam, Germany.
38Portland State Univ, Sch Community Hlth, Portland, OR 97207 USA.
39Univ New South Wales, St Vincents Clin Sch, Sydney, NSW, Australia.
40Hellen Hlth Fdn, Athens, Greece.
41Univ Athens, Athens, Greece.
42Harvard TH Chan Sch Publ Hlth, Boston, MA USA.
43Univ Hawaii, Off Publ Hlth Studies, Honolulu, HI 96822 USA.
44Navarra Inst Hlth Res, IdiSNA, Inst Salud Publ Navarra, Pamplona, Spain.
45Red Invest Serv Salud Enfermedades Cronicas REDIS, Pamplona, Spain.
46Columbia Univ Irving, Med Ctr, New York, NY USA.
47East Boston Neighborhood Hlth Ctr, Boston, MA USA.
48Citta Salute Sci Torino Hosp, Turin, Italy.
49Univ Iowa, Coll Publ Hlth, Iowa City, IA USA.
50Consejeria Sanidad Principado Asturias, Oviedo, Asturias, Spain.
51ASP, Civic M Arezzo Hosp, Ragusa, Italy.
52Duke Univ, Duke Div Sch, Durham, NC USA.
53Hirosaki Univ, Dept Endocrinol & Metab, Hirosaki, Aomori, Japan.
54Univ Naples Federico II, Dept Clin & Expt Med, Naples, Italy.
55Tuskegee Univ, Dept Biol, Tuskegee, AL 36088 USA.
56UiT Arctic Univ Norway, Dept Community Med, Tromso, Norway.
57Univ Helsinki, Helsinki, Finland.
58Helsinki Univ Hosp, Helsinki, Finland.
59Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland.
60Canc Registry Norway, Inst Population Based Canc Res, Oslo, Norway.
61Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
62Univ Helsinki, Epidemiol Grp, Folkhalsan Res Ctr, Fac Med, Helsinki, Finland.
63Univ South Carolina, Med, Charleston, SC USA.
64Univ Washington, Cardiovasc Hlth Res Unit, Dept Med, Seattle, WA 98195 USA.
65Univ Washington, Cardiovasc Hlth Res Unit, Dept Epidemiol, Seattle, WA 98195 USA.
66Univ Washington, Cardiovasc Hlth Res Unit, Dept Hlth Serv, Seattle, WA 98195 USA.
67Kaiser Permanente Washington Hlth Res Inst, Seattle, WA USA.
68Wageningen Univ, Dept Agrotechnol & Food Sci, Wageningen, Netherlands.
69Univ Groningen, Univ Med Ctr Groningen, Fac Med Sci, Groningen, Netherlands.
70Yale Univ, Sch Med, New Haven, CT USA.
71Univ Granada, Hospit Univ Granada, Inst Invest Biosanitaria ibs GRANADA, Escuela Andaluza Salud Publ, Granada, Spain.
72CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain.
73Fdn IRCCS Ist Nazl Tumori, Epidemiol & Prevent Unit, Milan, Italy.
74Canc Res & Prevent Inst ISPO, Florence, Italy.
75IMIB Arrixaca, Murcia Reg Hlth Council, Murcia, Spain.
76Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland.
77Uppsala Univ, Dept Med Sci, Uppsala, Sweden.
78Basque Govt, Inst Biodonostia, San Sebastian, Spain.
79Univ Sydney, Sydney, NSW, Australia.
80Royal Prince Alfred Hosp, Sydney, NSW, Australia.
81Kyushu Univ, Dept Prevent Med & Publ Hlth, Fukuoka, Japan.
82Harokopio Univ, Sch Hlth Sci & Educ, Athens, Greece.
83Univ Calif San Diego, Dept Family Med & Publ Hlth, San Diego, CA 92103 USA.
84Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands.
85Aalborg Univ Hosp, Aalborg, Denmark.
86Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.
87Univ Cambridge, Med Res Council Epidemiol Unit, Cambridge, England.
88Laval Univ, Dept Kinesiol, Quebec City, PQ, Canada.
89Univ Vermont, Dept Med, Burlington, VT USA.
90Wake Forest Univ, Bowman Gray Sch Med, Winston Salem, NC USA.
91Wake Forest Baptist Med Ctr, Winston Salem, NC USA.
92Kanazawa Med Univ, Dept Social & Environm Med, Kanazawa, Ishikawa, Japan.
93Baker IDI Heart & Diabet Inst, Melbourne, Vic, Australia.
94Populat Med Res Inst, Busselton, WA, Australia.
95Univ Western Australia, Sch Populat & Global Hlth, Perth, WA, Australia.
96Helmholtz Zentrum Munchen German Res Ctr Environm, Munich, Germany.
97Danish Canc Soc Res Ctr, Copenhagen, Denmark.
98Heidelberg Univ, Div Clin Epidemiol & Aging Res, Heidelberg, Germany.
99Ist Supe Sanita, Rome, Italy.
100Inst Pasteur, Lille, France.
101Assmann Stiftung Pravent, Munster, Germany.
102CUNY City Coll, New York, NY USA.
103Howard Univ Hosp, Washington, DC USA.
104Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland.
105Johns Hopkins Univ, Sch Med, Baltimore, MD USA.
106Int Agcy Res Canc, Lyon, France.
107Univ Bristol, MRC Integrat Epidemiol Unit IEU, Bristol, Avon, England.
108Univ Auckland, Sch Populat Hlth, Auckland, New Zealand.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2019071022988
Language: English
Published: Elsevier, 2018
Publish Date: 2019-07-10
Description:

Abstract

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.

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Series: The Lancet
ISSN: 0140-6736
ISSN-E: 1474-547X
ISSN-L: 0140-6736
Volume: 391
Issue: 10129
Pages: 1513 - 1523
DOI: 10.1016/S0140-6736(18)30134-X
OADOI: https://oadoi.org/10.1016/S0140-6736(18)30134-X
Type of Publication: A1 Journal article – refereed
Field of Science: 3141 Health care science
3142 Public health care science, environmental and occupational health
Subjects:
Article
Funding: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
Copyright information: © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
  https://creativecommons.org/licenses/by/4.0/