1. Mild-to-moderate alcohol consumption among those with cardiovascular disease does not appear to increase risk of mortality or future cardiovascular events.
2. Lower levels of alcohol consumption are associated with best outcomes.
Evidence Rating Level: 2 (Good)
The relation between alcohol and adverse cardiovascular outcomes is not fully clear, with variability between types of alcohol and frequency and quantity of use. Mild consumption is thought to be protective against cardiovascular concerns in otherwise healthy individuals. However, among those with cardiovascular disease (CVD), this protective capacity is unknown. This retrospective study investigated the association between alcohol consumption and prognosis in those with CVD through a series of meta-analyses of new data from three-large scale cohorts. A total of 14,386 patients with angina, myocardial infarction, or stroke in the UK Biobank Study were assessed, along with 12 published studies that added 31,235 participants. A combined sample of 48,423 was used based on availability of each outcome measure to determine the best-fitting dose-response association. Alcohol consumption was associated with all outcomes, with a risk reduction peaking at 6g/day (relative risk = .50, 95% CI .26 to .96) for cardiovascular events, 7g/day (RR = .79, 95% CI .73 to .85) for all-cause mortality, and 8g/day (RR = .73, 95% CI .64 to .83) for cardiovascular mortality. These associations remained significant up to 15g/day, 62g/day, and 50g/day, respectively, adjusting for age, sex, and smoking status. Overall, this study of individuals with CVD suggests that abstinence from alcohol may not be necessary for secondary prevention. However, it should be noted that lower drinking is likely to be associated with the lowest risk of mortality and having a future cardiovascular event (<105g/day).
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