为进行比较风险评估而模拟酒精消费对心血管疾病死亡率的影响：概述
Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview.
作者信息
Rehm Jürgen, Shield Kevin D, Roerecke Michael, Gmel Gerrit
机构信息
Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, ON, Canada.
Addiction Policy, Dalla Lana School of Public Health, University of Toronto (UofT), 155 College Street, 6th FL, Toronto, M5T 3 M7, ON, Canada.
出版信息
BMC Public Health. 2016 Apr 28;16:363. doi: 10.1186/s12889-016-3026-9.
BACKGROUND
Although alcohol consumption has long been considered as a risk factor for chronic disease, the relationship to cardiovascular disease (CVD) is complex and involves at least two dimensions: average volume of alcohol consumption and patterns of drinking. The objective of this contribution was to estimate the burden of CVD mortality caused by alcohol consumption.
METHODS
Risk assessment modelling with alcohol-attributable CVD mortality as primary outcome. The mortality burden of ischaemic heart disease (IHD) and ischaemic stroke (IS) attributable to alcohol consumption was estimated using attributable-fraction methodology. Relative Risk (RR) data for IHD and IS were obtained from the most comprehensive meta-analyses (except for Russia and surrounding countries where alcohol RR data were obtained from a large cohort study). Age-group specific RRs were calculated, based on large studies. Data on mortality were obtained from the World Health Organization's Global Health Estimates and alcohol consumption data were obtained from the Global Information System on Alcohol and Health. Risk of former drinkers was modelled taking into account global differences in the prevalence of sick quitters among former drinkers. Alcohol-attributable mortality estimates for all other CVD causes except IHD and IS were obtained from the 2014 Global Status Report on Alcohol and Health.
RESULTS
An estimated 780,381 CVD deaths (441,893 and 338,490 CVD deaths among men and women respectively) were attributable to alcohol consumption globally in 2012, accounting for 1.4 % of all deaths and 26.6 % of all alcohol-attributable deaths. This is in contrast to the previously estimated 1,128,273 CVD deaths attributable to alcohol consumption globally, and represents a decrease of 30.8 % in alcohol-attributable CVD mortality and of 10.6 % in the global burden of all alcohol-attributable deaths.
CONCLUSIONS
When the most comprehensive and recent systematic reviews and meta-analyses are taken as bases, the net impact of alcohol consumption on CVD is lower than previously estimated.
背景
尽管长期以来饮酒一直被视为慢性病的一个风险因素，但饮酒与心血管疾病（CVD）之间的关系很复杂，至少涉及两个方面：平均饮酒量和饮酒模式。本研究的目的是评估饮酒导致的心血管疾病死亡负担。
方法
以酒精所致心血管疾病死亡率作为主要结果进行风险评估建模。采用归因分数法估计饮酒所致缺血性心脏病（IHD）和缺血性中风（IS）的死亡负担。IHD和IS的相对风险（RR）数据来自最全面的荟萃分析（俄罗斯及周边国家的酒精RR数据来自一项大型队列研究）。根据大型研究计算特定年龄组的RR。死亡率数据来自世界卫生组织的全球卫生估计数，饮酒数据来自全球酒精与健康信息系统。考虑到全球范围内既往饮酒者中患病戒酒者患病率的差异，对既往饮酒者的风险进行了建模。除IHD和IS外，所有其他心血管疾病病因的酒精归因死亡率估计数来自《2014年酒精与健康全球状况报告》。
结果
2012年全球估计有780381例心血管疾病死亡（男性和女性分别为441893例和338490例）可归因于饮酒，占所有死亡人数的1.4%，占所有酒精归因死亡人数的26.6%。这与之前估计的全球1128273例可归因于饮酒的心血管疾病死亡人数形成对比，代表酒精所致心血管疾病死亡率下降了30.8%，全球所有酒精归因死亡负担下降了10.6%。
结论
以最全面和最新的系统评价及荟萃分析为基础时，饮酒对心血管疾病的净影响低于之前的估计。
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