A burden of proof study on alcohol consumption and ischemic heart disease

Sinclair Carr; Dana Bryazka; Susan A McLaughlin; Peng Zheng; Sarasvati Bahadursingh; Aleksandr Y Aravkin; Simon I Hay; Hilary R Lawlor; Erin C Mullany; Christopher J L Murray; Sneha I Nicholson; Jürgen Rehm; Gregory A Roth; Reed J D Sorensen; Sarah Lewington; Emmanuela Gakidou

doi:10.1038/s41467-024-47632-7

A burden of proof study on alcohol consumption and ischemic heart disease

Nat Commun. 2024 May 14;15(1):4082. doi: 10.1038/s41467-024-47632-7.

Authors

Sinclair Carr¹, Dana Bryazka², Susan A McLaughlin², Peng Zheng^{2

3}, Sarasvati Bahadursingh⁴, Aleksandr Y Aravkin^{2

3

5}, Simon I Hay^{2

3}, Hilary R Lawlor², Erin C Mullany², Christopher J L Murray^{2

3}, Sneha I Nicholson², Jürgen Rehm^{6

7

8

9

10

11

12

13}, Gregory A Roth^{2

3

14}, Reed J D Sorensen², Sarah Lewington⁴, Emmanuela Gakidou^{2

3}

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. scarr@hsph.harvard.edu.
² Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
³ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
⁴ Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK.
⁵ Department of Applied Mathematics, University of Washington, Seattle, WA, USA.
⁶ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁷ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁸ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁹ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹⁰ Faculty of Medicine, Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada.
¹¹ World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.
¹² Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
¹³ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
¹⁴ Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.

Abstract

Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk - specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males - while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Alcohol Drinking* / epidemiology
Case-Control Studies
Cohort Studies
Female
Humans
Male
Mendelian Randomization Analysis*
Myocardial Infarction / epidemiology
Myocardial Ischemia* / epidemiology
Risk Factors