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



      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.


      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.


      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.

      Abbreviations and Acronyms:

      ACM (all-cause mortality), CHD (coronary heart disease), CVD (cardiovascular disease), RR (relative risk)
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        • Rehm J.
        • Mathers C.
        • Popova S.
        • Thavorncharoensap M.
        • Teerawattananon Y.
        • Patra J.
        Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.
        Lancet. 2009; 373: 2223-2233
        • Di Castelnuovo A.
        • Costanzo S.
        • Bagnardi V.
        • Donati M.B.
        • Iacoviello L.
        • de Gaetano G.
        Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies.
        Arch Intern Med. 2006; 166: 2437-2445
        • Rimm E.B.
        • Klatsky A.
        • Grobbee D.
        • Stampfer M.J.
        Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits.
        BMJ. 1996; 312: 731-736
        • Ronksley P.E.
        • Brien S.E.
        • Turner B.J.
        • Mukamal K.J.
        • Ghali W.A.
        Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis.
        BMJ. 2011; 342: d671
        • O’Keefe J.H.
        • Bhatti S.K.
        • Bajwa A.
        • Dinicolantonio J.J.
        • Lavie C.J.
        Alcohol and cardiovascular health: the dose makes the poison…or the remedy.
        Mayo Clin Proc. 2014; 89: 382-393
        • Renaud S.C.
        • Guéguen R.
        • Conard P.
        • Lanzmann-Petithory D.
        • Orgogozo J.M.
        • Henry O.
        Moderate wine drinkers have lower hypertension-related mortality: a prospective cohort study in French men.
        Am J Clin Nutr. 2004; 80: 621-625
        • Rantakömi S.H.
        • Laukkanen J.A.
        • Sivenius J.
        • Kauhanen J.
        • Kurl S.
        Alcohol consumption and the risk of stroke among hypertensive and overweight men.
        J Neurol. 2013; 260: 534-539
        • Chobanian A.V.
        • Bakris G.L.
        • Black H.R.
        • et al.
        • National Heart, Lung, and Blood Institute, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee
        The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
        JAMA. 2003; 289: 2560-2572
        • Mancia G.
        • Fagard R.
        • Narkiewicz K.
        • et al.
        2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
        Eur Heart J. 2013; 34: 2159-2219
        • Briasoulis A.
        • Agarwal V.
        • Messerli F.H.
        Alcohol consumption and the risk of hypertension in men and women: a systematic review and meta-analysis.
        J Clin Hypertens (Greenwich). 2012; 14: 792-798
        • Ikehara S.
        • Iso H.
        • Toyoshima H.
        • et al.
        • Japan Collaborative Cohort Study Group
        Alcohol consumption and mortality from stroke and coronary heart disease among Japanese men and women: the Japan collaborative cohort study.
        Stroke. 2008; 39: 2936-2942
        • Wang F.
        • Yeung K.L.
        • Chan W.C.
        • et al.
        A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer.
        Ann Oncol. 2013; 24: 2724-2732
        • Hu E.A.
        • Pan A.
        • Malik V.
        • Sun Q.
        White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review.
        BMJ. 2012; 344: e1454
        • Fedirko V.
        • Tramcere I.
        • Bagnardi V.
        • et al.
        Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies.
        Ann Oncol. 2011; 22: 1958-1972
        • Koppes L.L.
        • Dekker J.M.
        • Hendriks H.F.
        • Bouter L.M.
        • Heine R.J.
        Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients.
        Diabetologia. 2006; 49: 648-652
        • Higashiyama A.
        • Okamura T.
        • Watanabe M.
        • et al.
        Alcohol consumption and cardiovascular disease incidence in men with and without hypertension: the suita study.
        Hypertens Res. 2013; 36: 58-64
        • Jin M.
        • Cai S.
        • Guo J.
        • et al.
        Alcohol drinking and all cancer mortality: a meta-analysis.
        Ann Oncol. 2013; 24: 807-816
        • Ding M.
        • Bhupathiraju S.N.
        • Satija A.
        • van Dam R.M.
        • Hu F.B.
        Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies.
        Circulation. 2014; 129: 643-659
        • Orsini N.
        • Bellocco R.
        • Greenland S.
        Generalized least squares for trend estimation of summarized dose-response data.
        Stata J. 2006; 6: 40-57
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Palmer A.J.
        • Fletcher A.E.
        • Bulpitt C.J.
        • et al.
        Alcohol intake and cardiovascular mortality in hypertensive patients: report from the Department of Health Hypertension Care Computing Project.
        J Hypertens. 1995; 13: 957-964
        • Beulens J.W.
        • Rimm E.B.
        • Ascherio A.
        • Spiegelman D.
        • Hendriks H.F.
        • Mukamal K.J.
        Alcohol consumption and risk for coronary heart disease among men with hypertension.
        Ann Intern Med. 2007; 146: 10-19
        • Britton K.A.
        • Gaziano J.M.
        • Sesso H.D.
        • Djoussé L.
        Relation of alcohol consumption and coronary heart disease in hypertensive male physicians (from the Physicians’ Health Study).
        Am J Cardiol. 2009; 104: 932-935
        • Malinski M.K.
        • Sesso H.D.
        • Lopez-Jimenez F.
        • Buring J.E.
        • Gaziano J.M.
        Alcohol consumption and cardiovascular disease mortality in hypertensive men.
        Arch Intern Med. 2004; 164: 623-628
        • Bos S.
        • Grobbee D.E.
        • Boer J.M.
        • Verschuren W.M.
        • Beulens J.W.
        Alcohol consumption and risk of cardiovascular disease among hypertensive women.
        Eur J Cardiovasc Prev Rehabil. 2010; 17: 119-126
        • Freiberg M.S.
        • Chang Y.F.
        • Kraemer K.L.
        • Robinson J.G.
        • Adams-Campbell L.L.
        • Kuller L.L.
        Alcohol consumption, hypertension, and total mortality among women.
        Am J Hypertens. 2009; 22: 1212-1218
        • Djoussé L.
        • Gaziano J.M.
        Alcohol consumption and heart failure in hypertensive US male physicians.
        Am J Cardiol. 2008; 102: 593-597
        • Lindschou Hansen J.
        • Tolstrup J.S.
        • Jensen M.K.
        • et al.
        Alcohol intake and risk of acute coronary syndrome and mortality in men and women with and without hypertension.
        Eur J Epidemiol. 2011; 26: 439-447
        • Kim M.K.
        • Ko M.J.
        • Han J.T.
        Alcohol consumption and mortality from all-cause and cancers among 1.34 million Koreans: the results from the Korea national health insurance corporation’s health examinee cohort in 2000.
        Cancer Causes Control. 2010; 21: 2295-2302
        • Jung E.J.
        • Shin A.
        • Park S.K.
        • et al.
        Alcohol consumption and mortality in the Korean Multi-center Cancer Cohort Study.
        J Prev Med Public Health. 2012; 45: 301-308
        • Corrao G.
        • Bagnardi V.
        • Zambon A.
        • La Vecchia C.
        A meta-analysis of alcohol consumption and the risk of 15 diseases.
        Prev Med. 2004; 38: 613-619
        • Vliegenthart R.
        • Oei H.H.
        • van den Elzen A.P.
        • et al.
        Alcohol consumption and coronary calcification in a general population.
        Arch Intern Med. 2004; 164: 2355-2360
        • Femia R.
        • Natali A.
        • L’Abbate A.
        • Ferrannini E.
        Coronary atherosclerosis and alcohol consumption: angiographic and mortality data.
        Arterioscler Thromb Vasc Biol. 2006; 26: 1607-1612
        • Schminke U.
        • Luedemann J.
        • Berger K.
        • et al.
        Association between alcohol consumption and subclinical carotid atherosclerosis: the Study of Health in Pomerania.
        Stroke. 2005; 36: 1746-1752
        • Villegas R.
        • Salim A.
        • O’Halloran D.
        • Perry I.J.
        Alcohol intake and insulin resistance: a cross-sectional study.
        Nutr Metab Cardiovasc Dis. 2004; 14: 233-240
        • Estruch R.
        • Sacanella E.
        • Badia E.
        • et al.
        Different effects of red wine and gin consumption on inflammatory biomarkers of atherosclerosis: a prospective randomized crossover trial. Effects of wine on inflammatory markers.
        Atherosclerosis. 2004; 175: 117-123
        • Rimm E.B.
        • Williams P.
        • Fosher K.
        • Criqui M.
        • Stampfer M.J.
        Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors.
        BMJ. 1999; 319: 1523-1528
        • Agarwal D.P.
        Cardioprotective effects of light-moderate consumption of alcohol: a review of putative mechanisms.
        Alcohol Alcohol. 2002; 37: 409-415
        • Ross R.
        Atherosclerosis—an inflammatory disease.
        N Engl J Med. 1999; 340: 115-126
        • O’Keefe J.H.
        • Bybee K.A.
        • Lavie C.J.
        Alcohol and cardiovascular health: the razor-sharp double-edged sword.
        J Am Coll Cardiol. 2007; 50: 1009-1014
        • Janszky I.
        • Ericson M.
        • Blom M.
        • et al.
        Wine drinking is associated with increased heart rate variability in women with coronary heart disease.
        Heart. 2005; 91: 314-318
        • Overvad T.F.
        • Rasmussen L.H.
        • Skjøth F.
        • et al.
        Alcohol intake and prognosis of atrial fibrillation.
        Heart. 2013; 99: 1093-1099

      Linked Article

      • Ethanol Should Be Subjected to a Randomized Controlled Trial
        Mayo Clinic ProceedingsVol. 90Issue 1
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          The meta-analysis by Huang et al1 in the September 2014 issue of Mayo Clinic Proceedings revealed an association between low to moderate ethanol consumption and reduced risk of cardiovascular disease and all-cause mortality (ACM) in hypertensive patients. This study adds additional observational evidence to support the hypothesis that there is a J-shaped curve for ACM vs ethanol consumption, with minimum ACM observed in persons with a low-level long-term ethanol intake of about 10 g/d (about 1 standard serving or drink).
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