March 25, 2017

Teetotalling is bad for you

That's the conclusion of the research below. The findings are in fact fairly conventional.  Moderate drinkers get fewer strokes and heart attacks than either teetotallers or heavy drinkers.  The good old Golden Mean again.  All the associations were quite weak in absolute terms but are fairly high in the context of what one generally finds in medical research.  It is also interesting that the various subtypes of cardiovascular disease all seem to be alcohol influenced.  So the conclusion embodied in my heading above is reasonably safe.

What's amazing is the spin that "New Scientist" put on the findings.  Their conclusion is:

“This study suggests that sticking within alcohol guidelines may actually lower your risk of some heart conditions,” says Tracy Parker, of charity the British Heart Foundation, who was not involved in the study. “But it’s important to remember that the risks of drinking alcohol far outweigh any possible benefits. These findings are certainly no reason to start drinking alcohol if you don’t already.”

Which is actually the reverse of what the study found.  It's just do-gooder lying.  But when is lying doing good?  Far from "the risks of drinking alcohol outweighing any possible benefits", alcohol actually confers the benefit of helping you to live longer!  There were fewer "unheralded coronary deaths" [fatal heart attacks] among moderate drinkers.   That's a pretty good benefit.  The British Heart Foundation should fire the lying Tracy Parker.  She is a preacher of some Puritanical ideology, not a competent science commentator


Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records

Steven Bell et al.

Abstract

Objectives: To investigate the association between alcohol consumption and cardiovascular disease at higher resolution by examining the initial lifetime presentation of 12 cardiac, cerebrovascular, abdominal, or peripheral vascular diseases among five categories of consumption.

Design: Population based cohort study of linked electronic health records covering primary care, hospital admissions, and mortality in 1997-2010 (median follow-up six years).

Setting: CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).

Participants: 1 937 360 adults (51% women), aged ≥30 who were free from cardiovascular disease at baseline.

Main outcome measures: 12 common symptomatic manifestations of cardiovascular disease, including chronic stable angina, unstable angina, acute myocardial infarction, unheralded coronary heart disease death, heart failure, sudden coronary death/cardiac arrest, transient ischaemic attack, ischaemic stroke, intracerebral and subarachnoid haemorrhage, peripheral arterial disease, and abdominal aortic aneurysm.

Results: 114 859 individuals received an incident cardiovascular diagnosis during follow-up. Non-drinking was associated with an increased risk of unstable angina (hazard ratio 1.33, 95% confidence interval 1.21 to 1.45), myocardial infarction (1.32, 1.24 to1.41), unheralded coronary death (1.56, 1.38 to 1.76), heart failure (1.24, 1.11 to 1.38), ischaemic stroke (1.12, 1.01 to 1.24), peripheral arterial disease (1.22, 1.13 to 1.32), and abdominal aortic aneurysm (1.32, 1.17 to 1.49) compared with moderate drinking (consumption within contemporaneous UK weekly/daily guidelines of 21/3 and 14/2 units for men and women, respectively). Heavy drinking (exceeding guidelines) conferred an increased risk of presenting with unheralded coronary death (1.21, 1.08 to 1.35), heart failure (1.22, 1.08 to 1.37), cardiac arrest (1.50, 1.26 to 1.77), transient ischaemic attack (1.11, 1.02 to 1.37), ischaemic stroke (1.33, 1.09 to 1.63), intracerebral haemorrhage (1.37, 1.16 to 1.62), and peripheral arterial disease (1.35; 1.23 to 1.48), but a lower risk of myocardial infarction (0.88, 0.79 to 1.00) or stable angina (0.93, 0.86 to 1.00).

Conclusions: Heterogeneous associations exist between level of alcohol consumption and the initial presentation of cardiovascular diseases. This has implications for counselling patients, public health communication, and clinical research, suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary.

BMJ 2017;356:j909





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