title: Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults.
abstract: BACKGROUND
  Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking.
  
  
  METHODS
  Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day.
  
  
  RESULTS
  After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results.
  
  
  CONCLUSIONS
  These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.
authors.affiliation: Emerging Investigations and Analytic Methods Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. tbn7@cdc.gov
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Naimi
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brewer
authors.forename: Wayne H
authors.initials: WH
authors.lastname: Giles
authors.forename: George
authors.initials: G
authors.lastname: Mensah
authors.forename: Mary K
authors.initials: MK
authors.lastname: Serdula
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Hungerford
authors.forename: James
authors.initials: J
authors.lastname: Lando
authors.forename: Shapur
authors.initials: S
authors.lastname: Naimi
authors.forename: Donna F
authors.initials: DF
authors.lastname: Stroup
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004327:Drinking Behavior; D004522:Educational Status; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology