Alcohol intake associated with higher risk of stroke subtypes and lower non-fatal CHD risk

Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study

Literature - Ricci C, Wood A, Mulle D, et al. - BMJ 2018;361:k934

Introduction and Methods

Alcohol consumption has been associated with an elevated risk of stroke, while moderate alcohol consumption has been associated with a lower risk of coronary heart disease (CHD) [1,2]. Most information about the association of alcohol consumption with CVD is based on recent and not on long-term drinking habits. In this analysis of the EPIC-CVD study [3], the dose-response association of baseline and lifetime alcohol consumption with the risk of incident CHD and different stroke types was evaluated.

EPIC-CVD, a case-cohort study included in the EPIC (European Prospective Investigation into Cancer and nutrition) study [4], was designed to investigate the determinants of CVD [3]. Alcohol consumption was evaluated at baseline using validated dietary questionnaires, where participants reported the number of standard glasses of wine, beer, cider, sweet liquor, distilled spirits, or fortified wines they consumed daily or weekly during the 12 months before recruitment, as well as at the age of 20, 30, 40, and 50. The main endpoints were myocardial infarction, angina, hemorrhagic stroke, and ischemic stroke.

Main results

  • Out of a total of 32,549 participants, the median age at recruitment was 52 years, and the mean follow-up time was 12.5 years.
  • Average baseline alcohol consumption was 24 g/day in men and 10 g/day in women.
  • Lifetime alcohol consumption was available for 76% of participants in the EPIC study, and averaged 30 g/day in men, and 8 g/day in women.
  • Average baseline alcohol consumption was higher in former and current smokers compared with those who had never smoked.
  • There was an inverse association between alcohol consumption and non-fatal CHD (HR per 12 g/day increase: 0.94; 95%CI: 0.91-0.96; P<0.001 for trend).
  • For non-fatal CHD, compared with the reference group (0.1-4.9 g/day), the HR for consumption of 30.0-59.9 g/day was 0.73 (95%CI: 0.65-0.83), and the HR for consumption of at least 60.0 g/day was 0.68 (95%CI: 0.57-0.81).
  • There was a non-linear association between alcohol and fatal CHD (HR for 15.0-29.9 g/day: 0.65; 95%CI: 0.53-0.81; HR for >60.0 g/day: 0.98 (95%CI: 0.70-1.37).
  • There was a positive association between baseline alcohol consumption and non-fatal stroke (HR per 12 g/day increase: 1.04; 95%CI: 1.02-1.07), ischemic stroke (HR per 12g/day increase: 1.05; 95%CI: 1.02-1.09; P=0.001 for trend), and hemorrhagic stroke (HR per 12g/day increase: 1.10; 1.04-1.15; P<0.001 for trend).
  • Associations with CV outcomes were similar with average lifetime alcohol consumption and for baseline alcohol intake, and there was no strong evidence for interactions of alcohol consumption with smoking status.


Alcohol intake was inversely associated with the risk of non-fatal CHD, and positively associated with the risk of ischemic and hemorrhagic stroke. The associations with CV outcomes were similar with average lifetime and baseline alcohol consumption.


1. Bell S, Daskalopoulou M, Rapsomaniki E, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ 2017;356:j909.

2. Corrao G, Bagnardi V, Zambon A, et al. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004;38:613-9.

3. Wood AM, Kaptoge S, Butterworth AS, et al, Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group. Risk thresholds for alcohol consumption: combined analysis of individual participant data for 599 912 current drinkers in 83 prospective studies. Lancet 2018;391:1513-23

4. Riboli E, Hunt KJ, Slimani N, et al. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 2002;5(6b):1113-24.

Find this article online at BMJ 2018

Facebook Comments


We’re glad to see you’re enjoying PACE-CME…
but how about a more personalized experience?

Register for free