title: Twenty-year trajectories of alcohol consumption during midlife and atherosclerotic thickening in early old age: findings from two British population cohort studies.
abstract: Epidemiological evidence indicates a protective effect of light-moderate drinking on cardiovascular disease and an increased risk for heavier drinking. Nevertheless, the effect of alcohol on atherosclerotic changes in vessel walls is disputed. Most previous studies have only looked at the cross-sectional relationship between alcohol and carotid intima media thickness (cIMT) - a surrogate marker of atherosclerosis. Single measurements of alcohol assume that alcohol exposure is stable and ignore the possible cumulative effects of harm, leading to possibly incorrect inferences.
  
  
  
  Data were retrieved from two UK population based cohort studies: the Whitehall II cohort of civil servants and the MRC National Survey of Health and Development (combined sample size of 5403 men and women). Twenty year-drinking trajectories during midlife were linked to measures of cIMT when participants were in early old age, and adjusted for age, sex, socioeconomic position, ethnicity and smoking.
  
  
  
  Those who consistently drank heavily had an increased cIMT compared to stable moderate drinkers (pooled difference in cIMT 0.021 mm; 95 % CI 0.002 to 0.039), after adjustment for covariates. This was not detected in cross-sectional analyses. Former drinkers also had an increased cIMT compared to moderate drinkers (pooled difference in cIMT 0.021; 95 % CI 0.005 to 0.037). There were no appreciable differences in cIMT between non-drinkers and consistent moderate drinkers.
  
  
  
  The drinking habits among adults during midlife affect the atherosclerotic process and sustained heavy drinking is associated with an increased cIMT compared to stable moderate drinkers. This finding was not seen when only using cross-sectional analyses, thus highlighting the importance of taking a life course approach. There was no evidence of a favourable atherosclerotic profile from stable moderate drinking compared to stable non-drinking.
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. a.britton@ucl.ac.uk.
authors.forename: Annie
authors.initials: A
authors.lastname: Britton
authors.affiliation: MRC Unit for Lifelong Health & Ageing at University College London, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.affiliation: MRC Unit for Lifelong Health & Ageing at University College London, London, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Kuh
authors.affiliation: National Centre for Cardiovascular Prevention and Outcomes, UCL, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: National Centre for Cardiovascular Prevention and Outcomes, UCL, London, UK.
authors.forename: Marietta
authors.initials: M
authors.lastname: Charakida
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Bell
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000503:physiopathology; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D015992:Body Mass Index; D059168:Carotid Intima-Media Thickness / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002784:Cholesterol
keywords: Alcohol; Atherosclerosis; Life course; Longitudinal