title: Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis.
abstract: BACKGROUND
  Although considerable research describes the cardiovascular effects of habitual moderate and heavy alcohol consumption, the immediate risks following alcohol intake have not been well characterized. Based on its physiological effects, alcohol may have markedly different effects on immediate and long-term risk.
  
  
  RESULTS
  We searched CINAHL, Embase, and PubMed from inception to March 12, 2015, supplemented with manual screening for observational studies assessing the association between alcohol intake and cardiovascular events in the following hours and days. We calculated pooled relative risks and 95% confidence intervals for the association between alcohol intake and myocardial infarction, ischemic stroke, and hemorrhagic stroke using DerSimonian and Laird random-effects models to model any alcohol intake or dose-response relationships of alcohol intake and cardiovascular events. Among 1056 citations and 37 full-text articles reviewed, 23 studies (29 457 participants) were included. Moderate alcohol consumption was associated with an immediately higher cardiovascular risk that was attenuated after 24 hours, and even protective for myocardial infarction and hemorrhagic stroke (≈2-4 drinks: relative risk=30% lower risk) and protective against ischemic stroke within 1 week (≈6 drinks: 19% lower risk). In contrast, heavy alcohol drinking was associated with higher cardiovascular risk in the following day (≈6-9 drinks: relative risk=1.3-2.3) and week (≈19-30 drinks: relative risk=2.25-6.2).
  
  
  CONCLUSIONS
  There appears to be a consistent finding of an immediately higher cardiovascular risk following any alcohol consumption, but, by 24 hours, only heavy alcohol intake conferred continued risk.
authors.affiliation: From Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.M., H.S.C., M.A.M.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (E.M., E.B.R., M.A.M.); Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (H.S.C.); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.). emostofs@mail.harvard.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mostofsky
authors.affiliation: From Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.M., H.S.C., M.A.M.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (E.M., E.B.R., M.A.M.); Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (H.S.C.); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Chahal
authors.affiliation: From Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.M., H.S.C., M.A.M.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (E.M., E.B.R., M.A.M.); Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (H.S.C.); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: From Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.M., H.S.C., M.A.M.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (E.M., E.B.R., M.A.M.); Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (H.S.C.); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: From Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.M., H.S.C., M.A.M.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (E.M., E.B.R., M.A.M.); Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (H.S.C.); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.B.R.).
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D064887:Observational Studies as Topic / Q000379:methods; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000431:Ethanol
keywords: alcohol drinking; cardiovascular diseases; dose-response relationship, drug; epidemiology; meta-analysis