Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers
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BACKGROUND: Alcohol consumption is a major global risk factor for mortality and morbidity. Much discussion has revolved around the diverse findings on the complex relationship between alcohol consumption and the leading cause of death and disability, ischemic heart disease (IHD). METHODS: We conducted a systematic search of the literature up to August 2014 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify meta-analyses and observational studies examining the relationship between alcohol drinking, drinking patterns, and IHD risk, in comparison to lifetime abstainers. In a narrative review we have summarized the many meta-analyses published in the last 10 years, discussing the role of confounding and experimental evidence. We also conducted meta-analyses examining episodic heavy drinking among on average moderate drinkers. RESULTS: The narrative review showed that the use of current abstainers as the reference group leads to systematic bias. With regard to average alcohol consumption in relation to lifetime abstainers, the relationship is clearly J-shaped, supported by short-term experimental evidence and similar associations within strata of potential confounders, except among smokers. Women experience slightly stronger beneficial associations and also a quicker upturn to a detrimental effect at lower levels of average alcohol consumption compared to men. There was no evidence that chronic or episodic heavy drinking confers a beneficial effect on IHD risk. People with alcohol use disorder have an elevated risk of IHD (1.5- to 2-fold). Results from our quantitative meta-analysis showed that drinkers with average intake of <30 g/day and no episodic heavy drinking had the lowest IHD risk (relative risk = 0.64, 95% confidence interval 0.53 to 0.71). Drinkers with episodic heavy drinking occasions had a risk similar to lifetime abstainers (relative risk = 1.12, 95% confidence interval 0.91 to 1.37). CONCLUSIONS: Epidemiological evidence for a beneficial effect of low alcohol consumption without heavy drinking episodes is strong, corroborated by experimental evidence. However, episodic and chronic heavy drinking do not provide any beneficial effect on IHD. Thus, average alcohol consumption is not sufficient to describe the risk relation between alcohol consumption and IHD. Alcohol policy should try to reduce heavy drinking patterns.
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There is evidence for an increased risk associated with irregular heavy drinking, even in people who are on average light to moderate drinkers, for ischaemic heart disease, ischaemic stroke, all types of stroke, and different cardiovascular outcomes.
“but there is also evidence for an increased risk associated with irregular heavy drinking, even in people who are on average light to moderate drinkers (ischaemic heart disease 247, 248, 249; ischaemic stroke 250; all types of stroke 251; different cardiovascular outcomes 252).”
From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [248]
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- [97]Rehm J, Roerecke M: Time to rethink the ischaemic heart disease effects of low to moderate alcohol consumption?BMJ 2014, ᅟ:ᅟ. http://www.bmj.com/content/349/bmj.g4164/rapid-responses.
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Self-citation
- Authors
- Roerecke, M., & Rehm, J.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Roerecke, Michael
- Venue
- BMC Medicine
- Published
- 2014-10-21
- Volume
- 12
- Issue
- 1
- Pages
- 182-182
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC4203905
- OpenAlex
- W2158685553
- Cited by
- 342
- References
- 121
- Citations by year
- 2026: 25 · 2025: 22 · 2024: 29 · 2023: 30 · 2022: 39 · 2021: 34 · 2020: 31 · 2019: 24 · 2018: 29 · 2017: 35 · 2016: 30 · 2015: 14
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- Funders
- European Commission (2007–2013, FP7 2007-2013, 266813, FP7/2007)
- 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, ischemic heart disease, drinking patterns, episodic heavy drinking, moderate drinking, J-shaped dose-response relationship, alcoholism, sex differences, smoking confounding, alcohol policy
- MeSH terms
- Alcohol Drinking, Alcoholism, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Risk Factors, Myocardial Ischemia, Young Adult
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