Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records.
ObjectivesTo investigate the association between alcohol consumption and cardiovascular disease at higher resolution by examining the initial lifetime presentation of 12 cardiac, cerebrovascular, abdominal, or peripheral vascular diseases among five categories of consumption.DesignPopulation based cohort study of linked electronic health records covering primary care, hospital admissions, and mortality in 1997-2010 (median follow-up six years).SettingCALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants1 937 360 adults (51% women), aged ≥30 who were free from cardiovascular disease at baseline.Main outcome measures12 common symptomatic manifestations of cardiovascular disease, including chronic stable angina, unstable angina, acute myocardial infarction, unheralded coronary heart disease death, heart failure, sudden coronary death/cardiac arrest, transient ischaemic attack, ischaemic stroke, intracerebral and subarachnoid haemorrhage, peripheral arterial disease, and abdominal aortic aneurysm.Results114 859 individuals received an incident cardiovascular diagnosis during follow-up. Non-drinking was associated with an increased risk of unstable angina (hazard ratio 1.33, 95% confidence interval 1.21 to 1.45), myocardial infarction (1.32, 1.24 to1.41), unheralded coronary death (1.56, 1.38 to 1.76), heart failure (1.24, 1.11 to 1.38), ischaemic stroke (1.12, 1.01 to 1.24), peripheral arterial disease (1.22, 1.13 to 1.32), and abdominal aortic aneurysm (1.32, 1.17 to 1.49) compared with moderate drinking (consumption within contemporaneous UK weekly/daily guidelines of 21/3 and 14/2 units for men and women, respectively). Heavy drinking (exceeding guidelines) conferred an increased risk of presenting with unheralded coronary death (1.21, 1.08 to 1.35), heart failure (1.22, 1.08 to 1.37), cardiac arrest (1.50, 1.26 to 1.77), transient ischaemic attack (1.11, 1.02 to 1.37), ischaemic stroke (1.33, 1.09 to 1.63), intracerebral haemorrhage (1.37, 1.16 to 1.62), and peripheral arterial disease (1.35; 1.23 to 1.48), but a lower risk of myocardial infarction (0.88, 0.79 to 1.00) or stable angina (0.93, 0.86 to 1.00).ConclusionsHeterogeneous associations exist between level of alcohol consumption and the initial presentation of cardiovascular diseases. This has implications for counselling patients, public health communication, and clinical research, suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary.Registrationclinicaltrails.gov (NCT01864031).
Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK scb81@medschl.cam.ac.uk.|Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
Steven
S
Bell
Department of Infection and Population Health, University College London, Royal Free Hospital, London NW3 2PF, UK.
Marina
M
Daskalopoulou
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Eleni
E
Rapsomaniki
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Julie
J
George
Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
Annie
A
Britton
Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
Martin
M
Bobak
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Juan P
JP
Casas
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Caroline E
CE
Dale
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Spiros
S
Denaxas
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Anoop D
AD
Shah
Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK.
Harry
H
Hemingway
D000428:Alcohol Drinking / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D057286:Electronic Health Records; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012737:Sex Factors