Elsevier

Mayo Clinic Proceedings

Volume 89, Issue 9, September 2014, Pages 1201-1210
Mayo Clinic Proceedings

Original article
Association Between Alcohol Consumption and Risk of Cardiovascular Disease and All-Cause Mortality in Patients With Hypertension: A Meta-Analysis of Prospective Cohort Studies

https://doi.org/10.1016/j.mayocp.2014.05.014Get rights and content

Abstract

Objective

To conduct a meta-analysis summarizing the risk of cardiovascular disease (CVD) and all-cause mortality (ACM) in relation to alcohol consumption in patients with hypertension, focusing on clarifying dose-response associations.

Patients and Methods

PubMed and EMBASE were searched for eligible prospective cohort studies from December 3, 1949, through January 18, 2014. The semi-parameter method and dose-response analysis were used.

Results

Nine studies (11 cohorts) were included in the meta-analysis. Compared with the lowest alcohol level (abstainers/occasional drinkers), the pooled relative risk (RR) was 0.72 (95% CI, 0.68-0.77) for the third highest category (median, 10 g/d), 0.81 (95% CI, 0.71-0.93) for the second highest category (median, 20 g/d), and 0.60 (95% CI, 0.54-0.67) for the highest category (median, 30 g/d). A J-shaped relationship between alcohol use and ACM was observed, and the nadir (RR, 0.82; 95% CI, 0.76-0.88) was found to be at a dose of 8 to 10 g of alcohol consumption per day.

Conclusion

Findings of this meta-analysis suggest that low-to-moderate alcohol consumption was inversely significantly associated with the risk of CVD and ACM in patients with hypertension.

Section snippets

Search Strategy and Inclusion Criteria

PubMed and EMBASE were searched for prospective cohort studies that evaluated the association between alcohol consumption and the risk of ACM or CVD in patients with hypertension from December 3, 1949, to January 18, 2014. The search terms included the following key words: “alcohol OR ethanol OR beer OR wine OR spirits,” “stroke OR cerebral infarction OR brain infarction OR coronary heart disease OR intracerebral hemorrhage OR brain hemorrhage OR ([cerebrovascular OR cardiovascular OR CVD OR

Characteristics of Included Studies

After a prudent process of electronic search and identification, 9 relevant studies (11 cohorts)16, 22, 23, 24, 25, 26, 27, 28, 29 were included in this meta-analysis, with a total number of 394,840 participants. The quality scores ranged from 4.5 to 8.5, and the median was 6.5. Three studies were conducted in Europe,22, 26, 29 1 in Japan,16 and 5 in the United States.23, 24, 25, 27, 28 In 2 studies,16, 29 unadjusted RRs were recalculated taking the nondrinkers/occasional drinkers as the

Discussion

To our knowledge, this is the first meta-analysis of the association between alcohol drinking and the risk of CVD and ACM in patients with hypertension. For CVD, we found protective effects across different alcohol categories compared with abstainers/occasional drinkers, while a J-shaped relationship was observed for ACM. The greatest protective effect for ACM was observed at 8 to 10 g/d alcohol consumption, and significant beneficial effect was maintained from 0 to 26 g/d. In short, our

Conclusion

This meta-analysis shows that low-moderate alcohol consumption was associated with a significantly decreased risk of CVD and ACM among populations with hypertension. For CVD, alcohol in low moderation (<20 g/d, about 2 drinks/d) was associated with a 19% to 28% decreased overall CVD risk. In addition, the trend of alcohol drinking with ACM was found to be J-shaped, which suggests that no more than 26 g/d (about 2-3 drinks/d) of alcohol intake will benefit individuals with hypertension and

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    Grant Support: This work was supported by grants from the National Natural Science Foundation of China (grant no. 81372973). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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