Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records

Steven Bell, Marina Daskalopoulou, Eleni Rapsomaniki, Julie George, Annie Britton, Martin Bobak, Juan P Casas, Caroline E Dale, Spiros Denaxas, Anoop D Shah, Harry Hemingway, Steven Bell, Marina Daskalopoulou, Eleni Rapsomaniki, Julie George, Annie Britton, Martin Bobak, Juan P Casas, Caroline E Dale, Spiros Denaxas, Anoop D Shah, Harry Hemingway

Abstract

Objectives To investigate the association between alcohol consumption and cardiovascular disease at higher resolution by examining the initial lifetime presentation of 12 cardiac, cerebrovascular, abdominal, or peripheral vascular diseases among five categories of consumption.Design Population based cohort study of linked electronic health records covering primary care, hospital admissions, and mortality in 1997-2010 (median follow-up six years).Setting CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants 1 937 360 adults (51% women), aged ≥30 who were free from cardiovascular disease at baseline.Main outcome measures 12 common symptomatic manifestations of cardiovascular disease, including chronic stable angina, unstable angina, acute myocardial infarction, unheralded coronary heart disease death, heart failure, sudden coronary death/cardiac arrest, transient ischaemic attack, ischaemic stroke, intracerebral and subarachnoid haemorrhage, peripheral arterial disease, and abdominal aortic aneurysm.Results 114 859 individuals received an incident cardiovascular diagnosis during follow-up. Non-drinking was associated with an increased risk of unstable angina (hazard ratio 1.33, 95% confidence interval 1.21 to 1.45), myocardial infarction (1.32, 1.24 to1.41), unheralded coronary death (1.56, 1.38 to 1.76), heart failure (1.24, 1.11 to 1.38), ischaemic stroke (1.12, 1.01 to 1.24), peripheral arterial disease (1.22, 1.13 to 1.32), and abdominal aortic aneurysm (1.32, 1.17 to 1.49) compared with moderate drinking (consumption within contemporaneous UK weekly/daily guidelines of 21/3 and 14/2 units for men and women, respectively). Heavy drinking (exceeding guidelines) conferred an increased risk of presenting with unheralded coronary death (1.21, 1.08 to 1.35), heart failure (1.22, 1.08 to 1.37), cardiac arrest (1.50, 1.26 to 1.77), transient ischaemic attack (1.11, 1.02 to 1.37), ischaemic stroke (1.33, 1.09 to 1.63), intracerebral haemorrhage (1.37, 1.16 to 1.62), and peripheral arterial disease (1.35; 1.23 to 1.48), but a lower risk of myocardial infarction (0.88, 0.79 to 1.00) or stable angina (0.93, 0.86 to 1.00).Conclusions Heterogeneous associations exist between level of alcohol consumption and the initial presentation of cardiovascular diseases. This has implications for counselling patients, public health communication, and clinical research, suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary.Registration clinicaltrails.gov (NCT01864031).

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: 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.

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.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5594422/bin/bels037096.f1.jpg
Fig 1 Inclusion of patients in study of clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5594422/bin/bels037096.f2.jpg
Fig 2 Multivariable adjusted hazard ratios for aggregated cardiovascular endpoints for clinically recorded non-drinkers and former, occasional, and heavy drinkers compared with moderate drinkers in cohort of 1.93 million adults adjusted for age (and age2), sex, socioeconomic deprivation, and smoking status
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5594422/bin/bels037096.f3.jpg
Fig 3 Multivariable adjusted hazard ratios for cardiac cardiovascular diseases for clinically recorded non-drinkers and former, occasional, and heavy drinkers compared with moderate drinkers in cohort of 1.93 million adults adjusted for age (and age2), sex, socioeconomic deprivation, and smoking status
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5594422/bin/bels037096.f4.jpg
Fig 4 Multivariable adjusted hazard ratios for non-cardiac cardiovascular diseases for clinically recorded non-drinkers and former, occasional, and heavy drinkers compared with moderate drinkers in cohort of 1.93 million adults adjusted for age (and age2), sex, socioeconomic deprivation, and smoking status

References

    1. Fernández-Solà J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nat Rev Cardiol 2015;12:576-87. 10.1038/nrcardio.2015.91 .
    1. Mukamal KJ, Rimm EB. Alcohol consumption: risks and benefits. Curr Atheroscler Rep 2008;10:536-43. 10.1007/s11883-008-0083-2 .
    1. Roerecke M, Rehm J. The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis. Addiction 2012;107:1246-60. 10.1111/j.1360-0443.2012.03780.x .
    1. Roerecke M, Rehm J. Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Med 2014;12:182 10.1186/s12916-014-0182-6 .
    1. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011;342:d671 10.1136/bmj.d671 .
    1. Movva R, Figueredo VM. Alcohol and the heart: to abstain or not to abstain?Int J Cardiol 2013;164:267-76. 10.1016/j.ijcard.2012.01.030 .
    1. O’Keefe JH, Bybee KA, Lavie CJ. Alcohol and cardiovascular health: the razor-sharp double-edged sword. J Am Coll Cardiol 2007;50:1009-14. 10.1016/j.jacc.2007.04.089 .
    1. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ 2011;342:d636 10.1136/bmj.d636 .
    1. Mathews MJ, Liebenberg L, Mathews EH. The mechanism by which moderate alcohol consumption influences coronary heart disease. Nutr J 2015;14:33 10.1186/s12937-015-0011-6 .
    1. Chikritzhs T, Stockwell T, Naimi T, Andreasson S, Dangardt F, Liang W. Has the leaning tower of presumed health benefits from ‘moderate’ alcohol use finally collapsed?Addiction 2015;110:726-7. 10.1111/add.12828 .
    1. Fekjaer HO. Alcohol-a universal preventive agent? A critical analysis. Addiction 2013;108:2051-7. 10.1111/add.12104 .
    1. Stockwell T, Greer A, Fillmore K, Chikritzhs T, Zeisser C. How good is the science?BMJ 2012;344:e2276 , author reply e2294. 10.1136/bmj.e2276 .
    1. Roerecke M, Rehm J. Ischemic heart disease mortality and morbidity rates in former drinkers: a meta-analysis. Am J Epidemiol 2011;173:245-58. 10.1093/aje/kwq364 .
    1. Ng Fat L, Cable N, Shelton N. Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life course. Alcohol Clin Exp Res 2015;39:166-74. 10.1111/acer.12596 .
    1. Mukamal K. Alcohol intake and noncoronary cardiovascular diseases. Ann Epidemiol 2007;17(Suppl):S8-12. 10.1016/j.annepidem.2007.01.003 .
    1. Delude CM. Deep phenotyping: The details of disease. Nature 2015;527:S14-5. 10.1038/527S14a .
    1. Breslow RA, Mukamal KJ. Measuring the burden--current and future research trends: results from the NIAAA Expert Panel on Alcohol and Chronic Disease Epidemiology. Alcohol Res 2013;35:250-9..
    1. Newby LK. Understanding Population Cardiovascular Health: Harnessing the Power of Electronic Health Records. Circulation 2015;132:1303-4. 10.1161/CIRCULATIONAHA.115.018750 .
    1. Mozaffarian D, Benjamin EJ, Go AS, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2015;131:e29-322. 10.1161/CIR.0000000000000152 .
    1. Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med 2015;372:793-5. 10.1056/NEJMp1500523 .
    1. George J, Rapsomaniki E, Pujades-Rodriguez M, et al. How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People. Circulation 2015;132:1320-8. 10.1161/CIRCULATIONAHA.114.013797 .
    1. Pujades-Rodriguez M, Timmis A, Stogiannis D, et al. Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention. PLoS One 2014;9:e104671 10.1371/journal.pone.0104671 .
    1. Pujades-Rodriguez M, George J, Shah AD, et al. Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction. Int J Epidemiol 2015;44:129-41. 10.1093/ije/dyu218 .
    1. Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet 2014;383:1899-911. 10.1016/S0140-6736(14)60685-1 .
    1. Pujades-Rodriguez M, Duyx B, Thomas SL, Stogiannis D, Smeeth L, Hemingway H. Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases. Heart 2016;102:383-9. 10.1136/heartjnl-2015-308514 .
    1. Shah AD, Langenberg C, Rapsomaniki E, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol 2015;3:105-13. 10.1016/S2213-8587(14)70219-0 .
    1. Daskalopoulou M, George J, Walters K, et al. Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men. PLoS One 2016;11:e0153838 10.1371/journal.pone.0153838 .
    1. Pujades-Rodriguez M, Duyx B, Thomas SL, et al. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England. PLoS One 2016;11:e0151245 10.1371/journal.pone.0151245 .
    1. Denaxas SC, George J, Herrett E, et al. Data resource profile: cardiovascular disease research using linked bespoke studies and electronic health records (CALIBER). Int J Epidemiol 2012;41:1625-38. 10.1093/ije/dys188 .
    1. Gallagher AM, Puri S, van Staa TP. Linkage of the General Practice Research Database (GPRD) with other data sources. Pharmacoepidemiol Drug Saf 2011;20:S230-1.
    1. Mathur R, Bhaskaran K, Chaturvedi N, et al. Completeness and usability of ethnicity data in UK-based primary care and hospital databases. J Public Health (Oxf) 2014;36:684-92. 10.1093/pubmed/fdt116 .
    1. Herrett E, Gallagher AM, Bhaskaran K, et al. Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol 2015;44:827-36. 10.1093/ije/dyv098 .
    1. Herrett E, Shah AD, Boggon R, et al. Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study. BMJ 2013;346:f2350 10.1136/bmj.f2350 .
    1. Herrett E, Smeeth L, Walker L, Weston C. MINAP Academic Group. The Myocardial Ischaemia National Audit Project (MINAP). Heart 2010;96:1264-7. 10.1136/hrt.2009.192328 .
    1. Chisholm J. The Read clinical classification. BMJ 1990;300:1092 10.1136/bmj.300.6732.1092 .
    1. National Health Service. OPCS-4 Classification - NHS Connecting for Health.National Health Service, 2013.
    1. Department of Health. Sensible drinking: Report of an inter-departmental working group. Department of Health; 1995
    1. Noble M, McLennan D, Wilkinson K, et al. The English indices of deprivation 2007.Communities and Local Government, 2007.
    1. Sterne JAC, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009;338:b2393 10.1136/bmj.b2393 .
    1. Rehm J, Irving H, Ye Y, Kerr WC, Bond J, Greenfield TK. Are lifetime abstainers the best control group in alcohol epidemiology? On the stability and validity of reported lifetime abstention. Am J Epidemiol 2008;168:866-71. 10.1093/aje/kwn093 .
    1. Bell S, Kivimäki M, Batty GD. Subgroup analysis as a source of spurious findings: an illustration using new data on alcohol intake and coronary heart disease. Addiction 2015;110:183-4. 10.1111/add.12708 .
    1. Bergmann MM, Rehm J, Klipstein-Grobusch K, et al. The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study. Int J Epidemiol 2013;42:1772-90. 10.1093/ije/dyt154 .
    1. Mukamal KJ, Conigrave KM, Mittleman MA, et al. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med 2003;348:109-18. 10.1056/NEJMoa022095 .
    1. Reynolds K, Lewis B, Nolen JDL, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis. JAMA 2003;289:579-88. 10.1001/jama.289.5.579 .
    1. Chiuve SE, Rimm EB, Mukamal KJ, et al. Light-to-moderate alcohol consumption and risk of sudden cardiac death in women. Heart Rhythm 2010;7:1374-80. 10.1016/j.hrthm.2010.05.035 .
    1. Albert CM, Manson JE, Cook NR, Ajani UA, Gaziano JM, Hennekens CH. Moderate alcohol consumption and the risk of sudden cardiac death among US male physicians. Circulation 1999;100:944-50. 10.1161/01.CIR.100.9.944 .
    1. Larsson SC, Orsini N, Wolk A. Alcohol consumption and risk of heart failure: a dose-response meta-analysis of prospective studies. Eur J Heart Fail 2015;17:367-73. 10.1002/ejhf.228 .
    1. Camargo CA Jr, , Stampfer MJ, Glynn RJ, et al. Prospective study of moderate alcohol consumption and risk of peripheral arterial disease in US male physicians. Circulation 1997;95:577-80. 10.1161/01.CIR.95.3.577 .
    1. Stackelberg O, Björck M, Larsson SC, Orsini N, Wolk A. Alcohol consumption, specific alcoholic beverages, and abdominal aortic aneurysm. Circulation 2014;130:646-52. 10.1161/CIRCULATIONAHA.113.008279 .
    1. Andreasen TH, Bartek J Jr, , Andresen M, Springborg JB, Romner B. Modifiable risk factors for aneurysmal subarachnoid hemorrhage. Stroke 2013;44:3607-12. 10.1161/STROKEAHA.113.001575 .
    1. O’Donnell MJ, Xavier D, Liu L, et al. INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112-23. 10.1016/S0140-6736(10)60834-3 .
    1. Larsson SC, Wallin A, Wolk A, Markus HS. Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Med 2016;14:178 10.1186/s12916-016-0721-4 .
    1. Romelsjö A, Allebeck P, Andréasson S, Leifman A. Alcohol, mortality and cardiovascular events in a 35 year follow-up of a nationwide representative cohort of 50,000 Swedish conscripts up to age 55. Alcohol Alcohol 2012;47:322-7. 10.1093/alcalc/ags021 .
    1. Weikert C, Berger K, Heidemann C, et al. Joint effects of risk factors for stroke and transient ischemic attack in a German population: the EPIC Potsdam Study. J Neurol 2007;254:315-21. 10.1007/s00415-006-0358-x .
    1. Camargo CA Jr, , Stampfer MJ, Glynn RJ, et al. Moderate alcohol consumption and risk for angina pectoris or myocardial infarction in U.S. male physicians. Ann Intern Med 1997;126:372-5. 10.7326/0003-4819-126-5-199703010-00005 .
    1. Merry AH, Boer JM, Schouten LJ, et al. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study. BMC Cardiovasc Disord 2011;11:13 10.1186/1471-2261-11-13 .
    1. Zheng Y-L, Lian F, Shi Q, et al. Alcohol intake and associated risk of major cardiovascular outcomes in women compared with men: a systematic review and meta-analysis of prospective observational studies. BMC Public Health 2015;15:773 10.1186/s12889-015-2081-y .
    1. Bellis MA, Hughes K, Jones L, et al. Holidays, celebrations, and commiserations: measuring drinking during feasting and fasting to improve national and individual estimates of alcohol consumption. BMC Med 2015;13:113 10.1186/s12916-015-0337-0 .
    1. Arber S, McKinlay J, Adams A, Marceau L, Link C, O’Donnell A. Influence of patient characteristics on doctors’ questioning and lifestyle advice for coronary heart disease: a UK/US video experiment. Br J Gen Pract 2004;54:673-8..
    1. Ferrari P, Licaj I, Muller DC, et al. Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study. BMJ Open 2014;4:e005245 10.1136/bmjopen-2014-005245 .
    1. Smyth A, Teo KK, Rangarajan S, et al. PURE Investigators. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet 2015;386:1945-54. 10.1016/S0140-6736(15)00235-4 .
    1. Mortensen EL, Jensen HH, Sanders SA, Reinisch JM. Better psychological functioning and higher social status may largely explain the apparent health benefits of wine: a study of wine and beer drinking in young Danish adults. Arch Intern Med 2001;161:1844-8. 10.1001/archinte.161.15.1844 .
    1. Ruidavets J-B, Ducimetière P, Evans A, et al. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ 2010;341:c6077 10.1136/bmj.c6077 .
    1. Britton A, Ben-Shlomo Y, Benzeval M, Kuh D, Bell S. Life course trajectories of alcohol consumption in the United Kingdom using longitudinal data from nine cohort studies. BMC Med 2015;13:47 10.1186/s12916-015-0273-z .
    1. Dam MK, Hvidtfeldt UA, Tjønneland A, Overvad K, Grønbæk M, Tolstrup JS. Five year change in alcohol intake and risk of breast cancer and coronary heart disease among postmenopausal women: prospective cohort study. BMJ 2016;353:i2314 10.1136/bmj.i2314 .
    1. Bell S, Mehta G, Moore K, Britton A. Ten-year alcohol consumption typologies and trajectories of C-reactive protein, interleukin-6 and interleukin-1 receptor antagonist over the following 12 years: a prospective cohort study. J Intern Med 2017;281:75-85. 10.1111/joim.12544 .
    1. Britton A, Hardy R, Kuh D, Deanfield J, Charakida M, Bell S. Twenty-year trajectories of alcohol consumption during midlife and atherosclerotic thickening in early old age: findings from two British population cohort studies. BMC Med 2016;14:111 10.1186/s12916-016-0656-9 .
    1. Mukamal KJ, Ascherio A, Mittleman MA, et al. Alcohol and risk for ischemic stroke in men: the role of drinking patterns and usual beverage. Ann Intern Med 2005;142:11-9. 10.7326/0003-4819-142-1-200501040-00007 .
    1. Holmes MV, Dale CE, Zuccolo L, et al. InterAct Consortium. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ 2014;349:g4164 10.1136/bmj.g4164 .
    1. Glymour MM. Alcohol and cardiovascular disease. BMJ 2014;349:g4334 10.1136/bmj.g4334 .
    1. Rehm J, Shield KD, Roerecke M, Gmel G. Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview. BMC Public Health 2016;16:363 10.1186/s12889-016-3026-9 .
    1. Silverwood RJ, Holmes MV, Dale CE, et al. Alcohol-ADH1B Consortium. Testing for non-linear causal effects using a binary genotype in a Mendelian randomization study: application to alcohol and cardiovascular traits. Int J Epidemiol 2014;43:1781-90. 10.1093/ije/dyu187 .
    1. Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2012;344:e1389 10.1136/bmj.e1389 .
    1. Kyu HH, Bachman VF, Alexander LT, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ 2016;354:i3857 10.1136/bmj.i3857 .
    1. Mons U, Müezzinler A, Gellert C, et al. CHANCES Consortium. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ 2015;350:h1551 10.1136/bmj.h1551 .
    1. Department of Health. UK Chief Medical Officers’ alcohol guidelines review: Summary of the proposed new guidelines. Stationery Office; 2016.
    1. National Health and Medical Research Council. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Australian Government; 2009:1-179.
    1. American Heart Association. Alcohol and Heart Health. 2015.

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