title: At the heart of the problem - A person-centred, developmental perspective on the link between alcohol consumption and cardio-vascular events.
abstract: BACKGROUND
  The cardio-protective effect of alcohol has been the subject of a long-standing scientific controversy. Emerging evidence remains equivocal, as the validity of the dose-dependent J-shape association is tainted by conceptual, theoretical and methodological problems. A major impediment for a resolution on the matter is the lack of a life-long developmental approach to pinpoint alcohol's specific impact on the risk for cardio-vascular events (CVE).
  
  
  OBJECTIVE
  Using retrospective and prospective individual-level data of alcohol consumption (AC) we applied a model-based clustering technique to uncover life-course trajectories of AC and explored their links to CVE.
  
  
  METHODS
  Data stemmed from a random sub-cohort of a large-scale, longitudinal study conducted in the Netherlands (N=2288). Group Based Trajectory Model (GBTM) was applied to extract distinct progressions of AC over time. Stratified by sex, the association between the developmental trajectories and CVE was examined with multiple logistic regression models, with adjustment for traditional risk factors.
  
  
  RESULTS
  GBTM analysis laid bare the heterogeneity of AC dynamics over the life-course, reiterating sex differences in drinking habits and CVE risk. AC temporal behaviors during adolescence and adulthood were diverse, but showed relative stability in in middle-age and elderly years. For males, adjusted odds for CVE differed among the uncovered developmental classes.
  
  
  CONCLUSIONS
  The findings elicited supportive evidence for a J-shape, but with a new twist. Besides moderation the results indicate that onset, timing, duration and stability of AC over the life-course are major aspects to be accounted for when attempting to elucidate alcohol's cardio-vascular role.
authors.affiliation: Maastricht University, Department of Methodology and Statistics, Peter Debyeplein 1, 6229HA, Maastricht, Limburg, Netherlands. Electronic address: valeria.limapassos@maastrichtuniversity.nl.
authors.forename: Valéria
authors.initials: V
authors.lastname: Lima Passos
authors.affiliation: Maastricht University, Department of Methodology and Statistics, Peter Debyeplein 1, 6229HA, Maastricht, Limburg, Netherlands.
authors.forename: Sven
authors.initials: S
authors.lastname: Klijn
authors.affiliation: Maastricht University, Department of Methodology and Statistics, Peter Debyeplein 1, 6229HA, Maastricht, Limburg, Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: van Zandvoort
authors.affiliation: Maastricht University, Department of Methodology and Statistics, Peter Debyeplein 1, 6229HA, Maastricht, Limburg, Netherlands.
authors.forename: Latifa
authors.initials: L
authors.lastname: Abidi
authors.affiliation: Maastricht University, Department of Methodology and Statistics, Peter Debyeplein 1, 6229HA, Maastricht, Limburg, Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Lemmens
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology / Q000639:trends*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Alcohol's cardio-protection; Developmental origins of health and disease; Group-based multitrajectory model; Lifecourse approach