Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study

Cristian Ricci, Angela Wood, David Muller, Marc J. Gunter, Antonio Agudo, Heiner Boeing, Yvonne T. Van Der Schouw, Samantha Warnakula, Calogero Saieva, Annemieke Spijkerman, Ivonne Sluijs, Anne Tjønneland, Cecilie Kyrø, Elisabete Weiderpass, Tilman Kühn, Rudolf Kaaks, Maria Jose Sánchez, Salvatore Panico, Claudia Agnoli, Domenico PalliRosario Tumino, Gunnar Engström, Olle Melander, Fabrice Bonnet, Jolanda M.A. Boer, Timothy J. Key, Ruth C. Travis, Kim Overvad, W. M.Monique Verschuren, J. Ramón Quirós, Antonia Trichopoulou, Eleni Maria Papatesta, Eleni Peppa, Conchi Moreno Iribas, Diana Gavrila, Ann Sofie Forslund, Jan Håkan Jansson, Giuseppe Matullo, Larraitz Arriola, Heinz Freisling, Camille Lassale, Ioanna Tzoulaki, Stephen J. Sharp, Nita G. Forouhi, Claudia Langenberg, Rodolfo Saracci, Michael Sweeting, Paul Brennan, Adam S. Butterworth, Elio Riboli, Nick J. Wareham, John Danesh, Pietro Ferrari*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


Objective To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. Design Multicentre case-cohort study. Setting A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries. Participants 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison. Main outcome measures Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke). Results There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events. Conclusions Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption.

Original languageEnglish
Article numberk934
JournalBritish Medical Journal
Publication statusPublished - 2018
Externally publishedYes

Bibliographical note

Funding Information:
30Navarre Public Health Institute, Institute for Health Research (IdiSNA), Pamplona, Spain 31Research Network in Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain 32Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain 33Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden 34Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Department of Medicine, Umeå University, Umeå, Sweden 35Department Medical Sciences, University of Torino, Italian Institute for Genomic Medicine -IIGM/HuGeF, Torino, Italy 36Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Gipuzkoa, Spain 37Department of Epidemiology and Public Health, University College London, London, UK 38Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece 39Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK 40Genetic Epidemiology Group, Genetics Section, International Agency for Research on Cancer, Lyon, France We thank Sarah Spackman (EPIC-CVD Data Manager, Cardiovascular Epidemiology Unit) and Nicola Kerrison (InterAct Data Manager, MRC Epidemiology Unit) for their help with this project. Contributors: AA, HB, AT, EW, RK, MS, SP, DP, RT, TJK, RCT, KO, WMMV, JRQ, AT, PM, LA, RS, NJW, ER, PF and JD collected, stored, and administered study participants’ information on lifestyle exposure within the EPIC study. NJW, CL, NGF, SJS, ASB, MS, ER, and JD designed the case-cohort study, and assessed and validated the cardiovascular disease (CVD) events within the EPIC-CVD study. CR, AMW, DM, MS, ASB, and PF performed the statistical analyses. CR, AMW, DM, MS, ASB, PF, RS, MJG, PB, and HF interpreted the results and prepared the first versions of the manuscript. All authors actively contributed to the final manuscript. PF is the guarantor. Funding: This work was supported by the Direction Générale de la Santé (French Ministry of Health) (grant GR-IARC-2003-09-12-01). EPIC-CVD has been supported by the European Union Framework 7 (HEALTH-F2-2012-279233), the European Research Council (268834), the UK Medical Research Council (G0800270 and MR/L003120/1), the British Heart Foundation (SP/09/002 and RG/08/014 and RG13/13/30194), and the UK National Institute of Health Research. The establishment of the random subcohort was supported by the EU Sixth Framework Programme (FP6) (grant LSHM_CT_2006_037197 to the InterAct project) and the Medical Research Council Epidemiology Unit (grants MC_UU_12015/1 and MC_UU_12015/5).

Publisher Copyright:
© 2018 Published by the BMJ Publishing Group Limited.


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