Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study
Open accessAbstract
Background Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms, and previous studies were mostly done in high-income countries. We investigated associations between alcohol consumption and outcomes in a prospective cohort of countries at different economic levels in five continents.Methods We included information from 12 countries participating in the Prospective Urban Rural Epidemiological (PURE) study, a prospective cohort study of individuals aged 35-70 years. We used Cox proportional hazards regression to study associations with mortality (n=2723), cardiovascular disease (n=2742), myocardial infarction (n=979), stroke (n=817), alcohol-related cancer (n=764), injury (n=824), admission to hospital (n=8786), and for a composite of these outcomes (n=11,963).Findings We included 114,970 adults, of whom 12,904 (11%) were from high-income countries (HICs), 24,408 (21%) were from upper-middle-income countries (UMICs), 48,845 (43%) were from lower-middle-income countries (LMICs), and 28,813 (25%) were from low-income countries (LICs). Median follow-up was 4.3 years (IQR 3.0-6.0). Current drinking was reported by 36,030 (31%) individuals, and was associated with reduced myocardial infarction (hazard ratio [HR] 0.76 [95% CI 0.63-0.93]), but increased alcohol-related cancers (HR 1.51 [1.22-1.89]) and injury (HR 1.29 [1.04-1.61]). High intake was associated with increased mortality (HR 1.31 [1.04-1.66]). Compared with never drinkers, we identified significantly reduced hazards for the composite outcome for current drinkers in HICs and UMICs (HR 0.84 [0.77-0.92]), but not in LMICs and LICs, for which we identified no reductions in this outcome (HR 1.07 [0.95-1.21]; pinteraction<0.0001).Interpretation Current alcohol consumption had differing associations by clinical outcome, and differing associations by income region. However, we identified sufficient commonalities to support global health strategies and national initiatives to reduce harmful alcohol use.Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
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A similar trend for stroke was not significant (p=0.15).
“In HIC/UMIC in the PURE study (272), current drinking was protective against MI, but not in LIC/LMIC (p=0·02 for interaction); a similar trend was seen for stroke, but the between-region difference was not significant (P=0.15 for interaction).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [272]
In all regions, men were more likely to be current drinkers than women.
“In all regions, men were more likely to be current drinkers than women (272).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [272]
In PURE, current drinking was protective against MI in HIC/UMIC but not in LIC/LMIC (p=0.02 for interaction).
“In HIC/UMIC in the PURE study (272), current drinking was protective against MI, but not in LIC/LMIC (p=0·02 for interaction); a similar trend was seen for stroke, but the between-region difference was not significant (P=0.15 for interaction).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [272]
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- Authors
- Smyth, A., Teo, K. K., Rangarajan, S., O'Donnell, M., Zhang, X., Rana, P., Leong, D. P., Dagenais, G., Seron, P., Rosengren, A., Schutte, A. E., Lopez-Jaramillo, P., Oguz, A., Chifamba, J., Diaz, R., Lear, S., Avezum, A., Kumar, R., Mohan, V., Szuba, A., Wei, L., Yang, W., Jian, B., McKee, M., & Yusuf, S.
- Affiliations
- Ollscoil na Gaillimhe – University of Galway (IE)
- Population Health Research Institute (CA)
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Sahlgrenska University Hospital (SE)
- North-West University (ZA)
- Istanbul Medeniyet University (TR)
- University of Zimbabwe (ZW)
- Simon Fraser University (CA)
- Post Graduate Institute of Medical Education and Research (IN)
- Madras Diabetes Research Foundation (IN)
- Wroclaw Medical University (PL)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Smyth, Andrew
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 386
- Issue
- 10007
- Pages
- 1945-1954
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W1687499721
- Cited by
- 230
- References
- 29
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 22 · 2023: 25 · 2022: 28 · 2021: 23 · 2020: 22 · 2019: 26 · 2018: 20 · 2017: 19 · 2016: 15 · 2015: 7
- FWCI
- 16.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Repositorio Universidad de Santander (submittedVersion, cc-by-nc-nd)
- Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
- Boloka Institutional Repository (North-west University) (submittedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Ministry of Science, Technology and Innovation of Malaysia (grant numbers 100–IRDC/BIOTEK 16/6/21 (13/2007) and 07-05-IFN-BPH010)
- Ministry of Higher Education of Malaysia (grant number 600-RMI/LRGS/5/3 (2/2011))
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pharmacology › Coffee research and impacts
- Keywords
- alcohol consumption, cardiovascular disease, myocardial infarction, stroke, alcohol-related cancer, injuries, hospitalization, mortality, income level, high-income countries, low-income countries, middle-income countries, PURE study, drinking patterns, socioeconomic gradient in health, alcohol marketing regulation, alcohol advertising regulation, alcohol taxation
- MeSH terms
- Adult, Aged, Alcohol Drinking, Cardiovascular Diseases, Developing Countries, Female, Hospitalization, Humans, Male, Middle Aged, Neoplasms, Wounds and Injuries, Cohort Studies, Proportional Hazards Models, Developed Countries
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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