Heavy alcohol consumption associated with more arterial stiffness
Twenty-Five-Year Alcohol Consumption Trajectories and Their Association With Arterial Aging: A prospective Cohort StudyO’Neill D, Britton A, Brunner EJ, et al. - J Am Heart Assoc. 2017;6:e005288
It is suggested that moderate levels of alcohol intake decrease the risk of cardiovascular disease, however underlying mechanisms are not fully understood, nor the impact of changes in drinking levels over time . Prior research suggests that the association between alcohol consumption and pulse wave velocity (PWV), a measure of arterial stiffness, follows a U-/J-shaped relationship [2-5].
Studies that have examined this association have predominantly relied on cross-sectional data, which mask longitudinal variability in consumption levels and hinder comparisons of former drinkers and non-drinkers [1,6]. Moreover, short-and long-term patterns of alcohol intake may have divergent effects on PWV .
Using repeating alcohol assessments that include data of more than 2 decades (obtained from the Whitehall II cohort study, 3 869 UK civil servants analysed for this study and recruited between 1985-1988), this study aimed to accurately capture the complexity of how drinking behaviour is associated with arterial stiffness. Primary aims were to determine whether long-term patterns of alcohol consumption are independently associated with baseline assessment of PWV and with longitudinal change in PWV. A secondary aim was to determine whether short-term intake levels showed comparable results. 73.7% of the analysed individuals were male and age ranged from 34-56 years. Last follow-up was in 2012-2013.
- Males were more often heavy drinker (stable 17.7%, unstable 28.6%), compared to women (stable 4.1%, unstable 19.0%). There were twice as many stable female non-drinkers (8.2%) and former female drinkers (18.7%) than male (3.0 and 8.8% respectively). Most were moderate drinkers.
- Mean PWV at baseline for males was 8.5 m/s (SD 2.0), which significantly increased to 9.1 m/s (SD 2.4) by follow-up (P<0.001). Mean for females increased from 8.2 m/s (SD 1.9) to 8.7 m/s (SD 2.3, P<0.001).
- Adjusting for various confounders, PWV of male but not female stable heavy drinkers was significantly higher at baseline (b=0.26 m/s, 95% CI 0.01-0.52, P=0.045). This was significant for females when not correcting for clinical co-variates (b=0.73 m/s, 95% CI 0.07-1.39, P=0.029).
- Former male drinkers showed significantly greater increases in PWV over time relative to stable male moderate drinkers (b=0.11 m/s, 95% CI 0.03-0.19, P=0.009). Correction for lifestyle and clinical characteristics did not change this association in this group or any of the long-term drinker types. Stable moderate drinkers had the lowest PWV values throughout the study period.
- In females, no significant longitudinal effect was found, although stable non-drinkers showed the largest (but non-significantly) longitudinal change in PWV.
- There was no significant difference in baseline PWV in either males or females in those without any recent intake and those with recent heavy intake, compared to recent moderate drinkers.
- Male participant with no recent reported intake had significantly higher PWV than those with recent moderate consumption (b=0.07 m/s, 95% CI 0.01-0.13, P=0.021).
This prospective data from 25 years of alcohol consumption revealed that male heavy drinkers had significantly higher baseline PWV than male moderate consumers, meaning high CV risk for these individuals. Furthermore, all drinker types, regardless of gender, showed increases in their PWV from baseline across a subsequent 4-5 year interval, but only male former drinkers showed significantly accelerated progression.