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Cited by 99Alcohol Consumption and Health EffectsSubstance Abuse Treatment and OutcomesNutritional Studies and Diet

Effect of alcohol on risk of coronary heart disease and stroke: causality, bias, or a bit of both?

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Emberson, Jonathan R, Bennett, Derrick A·2006·Vascular Health and Risk Management
DOI 10.2147/vhrm.2006.2.3.239PMC PMC1993990
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Abstract

Epidemiological studies of middle-aged populations generally find the relationship between alcohol intake and the risk of coronary heart disease (CHD) and stroke to be either U- or J-shaped. This review describes the extent that these relationships are likely to be causal, and the extent that they may be due to specific methodological weaknesses in epidemiological studies. The consistency in the vascular benefit associated with moderate drinking (compared with non-drinking) observed across different studies, together with the existence of credible biological pathways, strongly suggests that at least some of this benefit is real. However, because of biases introduced by: choice of reference categories; reverse causality bias; variations in alcohol intake over time; and confounding, some of it is likely to be an artefact. For heavy drinking, different study biases have the potential to act in opposing directions, and as such, the true effects of heavy drinking on vascular risk are uncertain. However, because of the known harmful effects of heavy drinking on non-vascular mortality, the problem is an academic one. Studies of the effects of alcohol consumption on health outcomes should recognise the methodological biases they are likely to face, and design, analyse and interpret their studies accordingly. While regular moderate alcohol consumption during middle-age probably does reduce vascular risk, care should be taken when making general recommendations about safe levels of alcohol intake. In particular, it is likely that any promotion of alcohol for health reasons would do substantially more harm than good.

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  • Beneficial effects of non-heavy drinking on ischaemic diseases may be overestimated using standard epidemiological methodology because of biased comparison groups.

    “and while they may be overestimated using standard epidemiological methodology because of biased comparison groups 260, biological pathways corroborate some protective effect.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [260]

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  1. Bobak M Marmot M Alcohol and mortality in Russia: is it different than elsewhere? Ann Epidemiol 1999 9 335 8 10475531

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Authors
Emberson, J. R., & Bennett, D. A.
Affiliations
University of Oxford (GB)
ORCID
Venue
Vascular Health and Risk Management
Publisher
Informa UK Limited
Published
2006-08
Volume
2
Issue
3
Pages
239-249
ISSN
1176-6344 (ISSN-L)
DOI
10.2147/vhrm.2006.2.3.239
PMC
PMC1993990
OpenAlex
W1985731068
Cited by
99
References
81
Citations by year
2025: 3 · 2024: 7 · 2023: 6 · 2022: 9 · 2021: 16 · 2020: 7 · 2019: 9 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 2 · 2013: 4 · 2012: 3
FWCI
0.27
Type
journal article
Language
en
Open access
Locations
  • Vascular Health and Risk Management (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (acceptedVersion)
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 › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
alcohol consumption, coronary artery disease, stroke, vascular risk, moderate drinking, heavy drinking, U-shaped relationship, J-shaped relationship, confounding, reference category, causal inference, middle-aged adults, alcohol promotion
MeSH terms
Alcohol Drinking, Ethanol, Blood Pressure, Coronary Disease, Hemostasis, Humans, Lipids, Risk Factors, Causality, Confounding Factors, Epidemiologic, Case-Control Studies, Stroke

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