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Heavy alcohol use, CV death link most prominent in those with low socioeconomic status
People with very frequent consumption of alcohol had increased risk for CV death only if they had low socioeconomic status, according to findings published in PLOS Medicine.
The researchers also found that those with moderately frequent alcohol consumption had reduced risk for CV death compared with individuals with infrequent alcohol consumption.
Eirik Degerud, PhD, a postdoctoral fellow at the Norwegian Institute of Public Health in Oslo, and colleagues analyzed 207,394 individuals from three Norwegian cohorts who self-reported alcohol consumption frequency from 1987 to 2003, as well as 32,616 binge-drinking episodes.
The researchers estimated CVD mortality risk using Cox models accounting for alcohol consumption, life course socioeconomic position, age, sex, smoking, physical activity, BMI, systolic BP, heart rate, triglyceride levels, diabetes, history of CVD and family history of CHD.
Participants were stratified by high, middle or low life course socioeconomic position, and by frequency of alcohol consumption.
During a mean 17 years of follow-up, there were 8,435 CVD deaths in the overall cohort and 2,284 CVD deaths in the group with data on binge drinking, the researchers reported.
Compared with those who consumed alcohol infrequently, defined as less than once per month, those who were moderately frequent consumers of alcohol, defined as two or three times per week, had lower risk for CVD mortality (HR = 0.78; 95% CI, 0.72-0.84), Degerud and colleagues wrote. This finding was consistent across high (HR = 0.66; 95% CI, 0.58-0.76), middle (HR = 0.87; 95% CI, 0.78-0.97) and low socioeconomic strata (HR = 0.79; 95% CI, 0.64-0.98).
Compared with infrequent drinkers, frequent drinkers, defined as those consuming four to seven drinks per week, had increased risk for CVD mortality if they had low socioeconomic status (HR = 1.42; 95% CI, 1.06-1.9) but reduced risk for CVD mortality if they had high (HR = 0.75; 95% CI, 0.63-0.9) or middle socioeconomic status (HR = 0.77; 95% CI, 0.64-0.92), according to the researchers.
“We knew that the risk of alcohol-related hospitalizations and deaths was higher among less affluent individuals on average, despite that they in general drink less frequently. It is referred to as the alcohol-harm paradox,” Degerud told Cardiology Today. “We now see that that the proposed benefit of alcohol on the risk of cardiovascular disease is more pronounced among those more affluent. But as there is no good reason why, mechanistically, alcohol should be more protective among those with an affluent background, we suspect that it is their affluent background that is the real reason behind the difference. This matters to understanding of whether alcohol has a protective effect or not. The finding also matters for public health, because the disease burden attributed to alcohol can be distorted if the studies contributing with data on the relationship between alcohol and health is performed in studies where affluent participants are overrepresented. This is very important.
“Our findings suggest that it is the affluent lifestyle that accompanies moderately frequent alcohol consumption, and perhaps not alcohol itself, that is the real reason why often observe that a glass of red wine each day reduces the risk of premature heart disease in the general population.”
Compared with people who did not binge drink the year before baseline, those who binged frequently, defined as at least once per week, had elevated risk for CVD mortality (HR = 1.58; 95% CI, 1.31-1.91). This was statistically significant in those with middle or low socioeconomic status but not in those with high socioeconomic status.
“The disease burden from alcohol globally, regionally and locally is calculated based on risk estimates from studies like the one we have performed,” Degerud told Cardiology Today. “These calculations are used to say something about how large of a problem alcohol really is. We show that the risk estimates vary by socioeconomic background, which together with other studies using other outcomes than cardiovascular disease, causes concern about whether we might be underestimating the burden of disease from alcohol, because people who participate in studies are normally have a higher socioeconomic position than the population overall. And risk estimates in Norway might not be comparable to risk estimates in New York, and risk estimates might differ within New York. Studies need to take this variation into account.”– by Erik Swain
For more information:
Eirik Degerud, PhD, can be reached at eirikmagnusmeek.degerud@fhi.no.
Disclosures: The authors report no relevant financial disclosures.