Background
Methods
Data sources, search strategy, and selection criteria
Data collection and quality assessment
Statistical analysis
Results
Studies and patient characteristics
Study | Country | Sex | Study design | Sample size | Age at baseline | Ex-drinker (%) | Light alcohol (%) | Moderate alcohol (%) | Heavy alcohol (%) | Follow-up (year) | Main outcomes | NOS score |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Framingham [24] | US | Men | Cohort | 3871 | >50 | 19.9 | 30.0 | 14.7 | 35.4 | 10.0 | Ischemic stroke | 8 |
Women | Cohort | 5300 | >50 | 37.9 | 39.1 | 9.6 | 13.4 | |||||
DANCOS [8] | Denmark | Men | Cohort | 12994 | 19–75 | 14.4 | 27.8 | 41.5 | 16.3 | 6.9 | Coronary disease, total mortality | 7 |
Women | Cohort | 13794 | 20–79 | 27.9 | 39.8 | 28.8 | 3.8 | |||||
EPOZ [25] | Netherlands | Men | Cohort | 760 | - | 6.7 | 17.6 | 38.6 | 37.1 | 10.0 | Cardiac death, total mortality | 6 |
Women | Cohort | 860 | - | 18.4 | 29.3 | 34.9 | 17.4 | |||||
MPC [10] | US | Men | Cohort | 13870 | >30 | 60.9 | 14.4 | 10.0 | 12.8 | 20.0 | Coronary disease, stroke, total mortality | 7 |
Women | Cohort | 13808 | >30 | 85.6 | 8.4 | 3.2 | 2.2 | |||||
NHEFS [26] | US | Men | Cohort | 768 | 46.3 | 17.8 | 63.8 | 7.0 | 11.5 | 17.0 | Total mortality | 5 |
Women | Cohort | 1286 | 45.7 | 36.7 | 56.5 | 3.2 | 3.7 | |||||
Whitehall II [27] | UK | Men | Cohort | 6840 | 35–55 | 13.0 | 45.6 | 12.6 | 28.7 | 11.0 | Coronary disease, total mortality | 7 |
Women | Cohort | 3374 | 35–55 | 29.1 | 54.8 | 11.4 | 4.7 | |||||
MONICA/KORA-Augsburg [28] | Germany | Men | Cohort | 1345 | 35–64 | 7.4 | 19.7 | 23.8 | 34.5 | 10.1 | Total mortality | 7 |
Women | Cohort | 1365 | 35–64 | 28.3 | 30.0 | 15.8 | - | |||||
MCCS [9] | Australia | Men | Cohort | 15156 | 40–69 | 13.2 | 39.9 | 20.8 | 16.1 | 11.4 | Coronary disease | 8 |
Women | Cohort | 23044 | 40–69 | 38.3 | 37.3 | 11.0 | - | |||||
CCHS [29] | Denmark | Men | Cohort | 5272 | >20 | 15.3 | - | 51.0 | 33.7 | 20.0 | Coronary disease, total mortality | 9 |
Women | Cohort | 6642 | >20 | 42.8 | - | 50.4 | 6.8 | |||||
HPFS and NHS [30] | US | Men | Cohort | 43685 | 54 | - | - | - | - | 18-20 | Total stroke, ischemic stroke | 6 |
Women | Cohort | 71243 | 50 | - | - | - | - | |||||
LWCS [31] | US | Men | Cohort | 4852 | 74 | 21.6 | 24.9 | 27.0 | 26.5 | 12.0 | Cardiac death | 7 |
Women | Cohort | 8444 | 73 | 27.7 | 35.4 | 21.3 | 15.7 | |||||
Denmark | Men | Cohort | 26035 | 50–65 | 4.9 | 52.3 | 11.9 | 30.9 | 5.7 | Coronary disease | 8 | |
Women | Cohort | 29427 | 50–65 | 15.8 | 66.0 | 9.2 | 9.0 | |||||
Japan | Men | Cohort | 34776 | 40–79 | 22.5 | 17.6 | 23.2 | 29.9 | 14.2 | Cardiac death, total mortality, stroke, ischemic stroke | 9 | |
Women | Cohort | 48906 | 40–79 | 83.5 | 12.0 | 2.1 | 0.7 | |||||
EPIC-Nutrition-Heidelberg [37] | Germany | Men | Cohort | 11062 | 42–62 | 30.0 | 31.0 | 30.0 | 9.0 | 12.0 | Total stroke | 7 |
Women | Cohort | 12865 | 37–62 | 60.0 | 22.0 | 13.0 | 5.0 | |||||
EPIC-Potsdam [38] | Germany | Men | Nested case-cohort | 815 | 35–65 | 3.2 | 33.4 | 24.5 | 38.9 | 8.2 | Coronary disease, stroke | 6 |
Women | Nested case-cohort | 1360 | 35–65 | 2.6 | 81.9 | 14.1 | 7.4 | |||||
EPIC-Spanish [39] | Spain | Men | Cohort | 15630 | 29–69 | 4.0 | 13.5 | 32.6 | 41.3 | 10.0 | Coronary disease | 7 |
Women | Cohort | 25808 | 29–69 | 35.1 | 33.8 | 21.3 | 3.0 | |||||
Netherlands | Men | Nested case-cohort | 1961 | 45–70 | - | - | - | - | 5.0 | Coronary disease, total mortality | 5 | |
Women | Nested case-cohort | 1713 | 45–70 | - | - | - | - | |||||
US | Men | Cohort | 10998 | >18 | - | 23.0 | 30.0 | 47.0 | 14.0 | Cardiac death, total mortality | 8 | |
Women | Cohort | 9767 | >18 | - | 33.3 | 36.6 | 31.1 |
Coronary disease
Outcomes | Categories of alcohol intake | Men (RR and 95 % CI) | Women (RR and 95 % CI) | Women compared with men (RRR and 95 % CI) |
---|---|---|---|---|
Coronary disease | Low | 0.67 (0.47–0.97)* | 0.70 (0.51–0.97)* | 1.01 (0.84–1.21) |
Moderate | 0.68 (0.50–0.93)* | 0.70 (0.52–0.94)* | 0.96 (0.75–1.23) | |
Heavy | 0.69 (0.49–0.96)* | 0.66 (0.44–0.99)* | 0.90 (0.66–1.22) | |
Total mortality | Low | 0.74 (0.60–0.92)* | 0.87 (0.71–1.07) | 1.07 (0.98–1.17) |
Moderate | 0.80 (0.68–0.95)* | 0.95 (0.83–1.08) | 1.10 (1.00–1.21)* | |
Heavy | 1.00 (0.81–1.22) | 1.20 (0.99–1.46) | 1.09 (0.99–1.21) | |
Cardiac death | Low | 0.93 (0.85–1.01) | 0.84 (0.71–0.99)* | 0.93 (0.83–1.04) |
Moderate | 0.85 (0.78–0.92)* | 0.86 (0.68–1.08) | 0.99 (0.87–1.14) | |
Heavy | 0.93 (0.70–1.23) | 1.04 (0.74–1.46) | 1.14 (0.99–1.32) | |
Stroke | Low | 0.89 (0.79–1.00) | 0.89 (0.76–1.06) | 0.99 (0.83–1.16) |
Moderate | 0.91 (0.81–1.02) | 0.79 (0.69–0.91)* | 0.90 (0.74–1.10) | |
Heavy | 1.19 (0.93–1.52) | 1.37 (0.92–2.04) | 1.35 (0.77–2.35) | |
Ischemic stroke | Low | 0.83 (0.69–0.99)* | 0.79 (0.68–0.92)* | 0.94 (0.74–1.20) |
Moderate | 0.91 (0.77–1.08) | 0.81 (0.67–0.96)* | 0.88 (0.66–1.16) | |
Heavy | 1.18 (0.96–1.44) | 1.12 (0.86–1.45) | 1.04 (0.80–1.36) |
Total mortality
Cardiac death, stroke, and ischemic stroke
Sensitivity analysis and subgroup analysis
Outcomes | Subgroup | Low alcohol intake | Moderate alcohol intake | Heavy alcohol intake |
---|---|---|---|---|
Coronary disease | Country | |||
US | 1.24 (0.72–2.13) | 2.17 (1.12–4.21)* | 1.25 (0.52–3.01) | |
Other | 0.98 (0.80–1.20) | 0.89 (0.75–1.23) | 0.87 (0.62–1.22) | |
Sample size | ||||
>10000 | 0.96 (0.80–1.16) | 0.98 (0.73–1.30) | 0.89 (0.63–1.25) | |
<10000 | 1.42 (0.82–2.45) | 0.93 (0.49–1.78) | 1.00 (0.40–2.49) | |
Adjusted physical activity | ||||
Yes | 1.01 (0.80–1.27) | 0.86 (0.66–1.12) | 0.85 (0.65–1.11) | |
No | 0.96 (0.63–1.48) | 1.24 (0.75–2.05) | 0.91 (0.35–2.38) | |
Adjusted serum cholesterol | ||||
Yes | 1.08 (0.84–1.38) | 0.96 (0.72–1.28) | 1.20 (0.80–1.78) | |
No | 0.93 (0.68–1.27) | 1.00 (0.64–1.57) | 0.75 (0.52–1.08) | |
Adjusted hypertension | ||||
Yes | 1.09 (0.85–1.40) | 0.76 (0.49–1.17) | 1.10 (0.68–1.80) | |
No | 0.92 (0.68–1.26) | 1.11 (0.83–1.48) | 0.77 (0.51–1.15) | |
Adjusted diabetes | ||||
Yes | 0.99 (0.78–1.27) | 0.82 (0.61–1.09) | 0.86 (0.66–1.12) | |
No | 1.01 (0.72–1.40) | 1.22 (0.84–1.78) | 0.83 (0.35–1.97) | |
Follow-up duration | ||||
More than 10 years | 1.01 (0.72–1.40) | 1.09 (0.83–1.43) | 0.86 (0.49–1.54) | |
Less than 10 years | 0.99 (0.78–1.27) | 0.75 (0.48–1.17) | 0.87 (0.63–1.21) | |
Study quality (NOS score) | ||||
8 or 9 | 0.76 (0.50–1.16) | 0.93 (0.74–1.17) | 0.70 (0.42–1.17) | |
<8 | 1.12 (0.90–1.39) | 0.98 (0.63–1.54) | 1.09 (0.76–1.55) | |
Total mortality | Country | |||
US | 1.06 (0.94–1.20) | 1.14 (0.97–1.33) | 1.16 (1.02–1.33)* | |
Other | 1.08 (0.94–1.24) | 1.07 (0.96–1.20) | 1.01 (0.87–1.18) | |
Sample size | ||||
>10000 | 1.06 (0.96–1.16) | 1.09 (0.99–1.19) | 1.08 (0.98–1.20) | |
<10000 | 1.36 (0.91–2.01) | 1.25 (0.77–2.03) | 1.63 (0.87–3.06) | |
Adjusted physical activity | ||||
Yes | 1.10 (0.96–1.26) | 1.08 (0.96–1.20) | 1.02 (0.87–1.18) | |
No | 1.05 (0.93–1.18) | 1.13 (0.97–1.32) | 1.16 (1.01–1.33)* | |
Adjusted serum cholesterol | ||||
Yes | 1.15 (0.73–1.80) | 1.21 (0.79–1.86) | 1.28 (0.61–2.65) | |
No | 1.07 (0.97–1.17) | 1.09 (0.99–1.19) | 1.09 (0.98–1.21) | |
Adjusted hypertension | ||||
Yes | 1.08 (0.94–1.24) | 1.08 (0.87–1.34) | 1.07 (0.83–1.37) | |
No | 1.06 (0.94–1.20) | 1.10 (0.99–1.21) | 1.10 (0.98–1.23) | |
Adjusted diabetes | ||||
Yes | 1.08 (0.93–1.24) | 1.07 (0.96–1.20) | 1.01 (0.87–1.18) | |
No | 1.07 (0.95–1.20) | 1.13 (0.97–1.31) | 1.16 (1.02–1.33)* | |
Follow-up duration | ||||
More than 10 years | 1.08 (0.98–1.19) | 1.09 (0.99–1.20) | 1.10 (0.99–1.22) | |
Less than 10 years | 0.99 (0.72–1.37) | 1.24 (0.76–2.03) | 1.04 (0.76–1.43) | |
Study quality (NOS score) | ||||
8 or 9 | 1.08 (0.95–1.23) | 1.08 (0.97–1.21) | 1.03 (0.88–1.20) | |
<8 | 1.06 (0.93–1.21) | 1.11 (0.95–1.30) | 1.15 (1.00–1.31)* |