Practice Update: Cardiology

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Relationship of Alcohol
Consumption to All-Cause,
Cardiovascular, and Cancer-
Related Mortality
JACC: Journal of the American College of Cardiology
Take-home message
• Data from the National Health Interview Survey and the National Death Index
records were analyzed to evaluate the association between alcohol consumption
and the risk of all-cause, cancer-, and cardiovascular disease (CVD)-associated
mortality. Light or moderate alcohol intake was significantly associated with a
reduced risk for all-cause mortality and CVD-specific mortality compared with
lifetime abstinence. Conversely, heavy alcohol consumption was significantly asso-
ciated with an increased risk for all-cause mortality and cancer-related mortality.
The risk of all-cause mortality and cancer-related mortality was also significantly
increased in the setting of binge drinking ≥1 day/week.
• While light and moderate alcohol consumption may have a protective effect on the
risk of all-cause and CVD-specific mortality, heavy drinking and binge drinking are
associated with an increased all-cause and cancer-specific mortality risk.
Abstract
BACKGROUND Previous studies have revealed
inconsistent findings regarding the associa-
tion of light to moderate alcohol consumption
with cardiovascular disease (CVD) and cancer
mortality.
OBJECTIVES The aim of this study was to examine
the association between alcohol consumption
and risk of mortality from all causes, cancer, and
CVD in U.S. adults.
METHODS Data were obtained by linking 13
waves of the National Health Interview Surveys
(1997 to 2009) to the National Death Index
records through December 31, 2011. A total of
333,247 participants ≥18 years of age were
included. Self-reported alcohol consumption
patterns were categorized into 6 groups: lifetime
abstainers; lifetime infrequent drinkers; former
drinkers; and current light, moderate, or heavy
drinkers. Secondary exposure included partici-
pants’ binge-drinking status. The main outcome
was all-cause, cancer, or CVD mortality.
RESULTS After a median follow-up of 8.2 years
(2.7 million person-years), 34,754 participants
died of all causes (including 8,947 CVD deaths
and 8,427 cancer deaths). Compared with
lifetime abstainers, those who were light or mod-
erate alcohol consumers were at a reduced risk
of mortality for all causes (light-hazard ratio [HR]:
0.79; 95% confidence interval [CI]: 0.76 to 0.82;
moderate-HR: 0.78; 95% CI: 0.74 to 0.82) and
CVD (light-HR: 0.74; 95% CI: 0.69 to 0.80; mod-
erate-HR: 0.71; 95% CI: 0.64 to 0.78), respectively.
In contrast, there was a significantly increased
risk of mortality for all causes (HR: 1.11; 95% CI:
1.04 to 1.19) and cancer (HR: 1.27; 95% CI: 1.13 to
1.42) in adults with heavy alcohol consumption.
Binge drinking ≥1 d/week was also associated
with an increased risk of mortality for all causes
(HR: 1.13; 95% CI: 1.04 to 1.23) and cancer (HR:
1.22; 95% CI: 1.05 to 1.41).
CONCLUSIONSLight and moderate alcohol intake
might have a protective effect on all-cause and
CVD-specific mortality in U.S. adults. Heavy or
binge drinking was associated with increased
risk of all-cause and cancer-specific mortality.
Relationship of alcohol consumption to all-
cause, cardiovascular, and cancer-related
mortality in US adults . J Am Coll Cardiol 2017
Aug 22;70(8)913-922, B Xi, SP Veeranki, M Zhao,
et al.
COMMENT
By Paul D Thompson MD
Picking Your Poison
How should we advise patients
regarding the risks and benefits
of alcohol consumption? Many
prior studies have suggested a J-shaped
relationship between alcohol and health,
meaning that risk is high both in those
who abstain from alcohol and those who
drink heavily, compared to low and mod-
erate drinkers. But many prior studies did
not correct for the “abstainer” effect. This
refers to the possibility that some abstain-
ers quit drinking but were former, perhaps
heavy, drinkers. Xi and colleagues (J
Am Coll Cardiol 2017;70:913–22) used
reported alcohol intake provided by
333,247 subjects in the 1997-2009
National Health Interview Surveys to
examine the relationship between alco-
hol consumption and all, cancer and
cardiovascular (CV) deaths in the United
States. Subjects were divided into lifetime
abstainers (<12 drinks ever), infrequent
drinkers (<12 drinks in any year), for-
mer drinkers (≥12 drinks in a previous
year), light (<3), moderate (>3 <15 drinks/
week for men and >3 <8 drinks/week
for women; and heavy current drinkers.
Binge drinking was defined as ≥5 drinks
in a day during the past year.
The median follow-up was 8.2 years.
Compared to abstainers, light and mod-
erate alcohol consumers had a 21 and
22% reduction in all-cause mortality and
a 26 and 29% reduction in cardiovas-
cular death. In contrast, heavy drinkers
had an 11% increase in total mortality
and a 27% increase in cancer mortality.
Binge drinking ≥1 per week was associ-
ated with a 13% increase in total and a
22% increase in cancer mortality.
These results support the J-shaped rela-
tionship between alcohol and health.
Light tomoderate alcohol intake appears
beneficial to total andCVhealthbut heavy
and binge drinking increase all cause and
cancer specific mortality. Patients who
wish should be permitted to imbibe but
discouraged from >2 daily drinks for men
and >1 daily drink for women.
Dr Thompson is Physician
Co-Director of the
Hartford Healthcare
Cardiovascular Institute,
Hartford, and Professor
of Medicine, University of
Connecticut, Storrs,
Connecticut.
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