Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands.
Julius Clinical Zeist the Netherlands.
J Am Heart Assoc. 2020 Apr 7;9(7):e014324. doi: 10.1161/JAHA.119.014324. Epub 2020 Mar 21.
Background Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease (CVD) and all-cause mortality compared with heavy drinkers and abstainers. To date, studies have relied on self-reported consumption, which may be prone to misclassification. Urinary ethyl glucuronide (EtG) is an alcohol metabolite and validated biomarker for recent alcohol consumption. We aimed to examine and compare the associations of self-reported alcohol consumption and EtG with CVD and all-cause mortality. Methods and Results In 5676 participants of the PREVEND (Prevention of Renal and Vascular End-Stage Disease) study cohort, EtG was measured in 24-hour urine samples and alcohol consumption questionnaires were administered. Participants were followed up for occurrence of first CVD and all-cause mortality. Cox proportional hazards regression models, adjusted for age, sex, and CVD risk factors, were fitted for self-reported consumption, divided into 5 categories: abstention, 1 to 4 units/month (reference), 2 to 7 units/week, 1 to 3 units/day, and ≥4 units/day. Similar models were fitted for EtG, analyzed as both continuous and categorical variables. Follow-up times differed for CVD (8 years; 385 CVD events) and all-cause mortality (14 years; 724 deaths). For both self-reported alcohol consumption and EtG, nonsignificant trends were found toward J-shaped associations between alcohol consumption and CVD, with higher risk in the lowest (hazard ratio for abstention versus 1-4 units/month, 1.42; 95% CI, 1.02-1.98) and highest drinking categories (hazard ratio for ≥4 units/day versus 1-4 units/month, 1.11; 95% CI, 0.68-1.84). Neither self-report nor EtG was associated with all-cause mortality. Conclusions Comparable associations with CVD events and all-cause mortality were found for self-report and EtG. This argues for the validity of self-reported alcohol consumption in epidemiologic research.
与重度饮酒者和戒酒者相比，适量饮酒与心血管疾病（CVD）和全因死亡率降低有关。迄今为止，研究依赖于自我报告的饮酒量，这可能容易出现分类错误。尿乙基葡萄糖醛酸（EtG）是一种酒精代谢物和最近饮酒的验证生物标志物。我们旨在检查和比较自我报告的饮酒量和 EtG 与 CVD 和全因死亡率的关联。
在 PREVEND（预防肾脏和血管终末期疾病）研究队列的 5676 名参与者中，测量了 24 小时尿液样本中的 EtG，并进行了酒精消费问卷。随访参与者首次发生 CVD 和全因死亡率。调整年龄、性别和 CVD 危险因素后，使用 Cox 比例风险回归模型拟合自我报告的饮酒量，分为 5 类：戒酒、1 至 4 单位/月（参考）、2 至 7 单位/周、1 至 3 单位/天和≥4 单位/天。类似的模型也适用于 EtG，分别作为连续和分类变量进行分析。CVD（8 年；385 例 CVD 事件）和全因死亡率（14 年；724 例死亡）的随访时间不同。对于自我报告的饮酒量和 EtG，饮酒量与 CVD 之间呈 J 形关联的趋势无统计学意义，最低（与 1-4 单位/月相比，戒酒的危险比为 1.42；95%置信区间为 1.02-1.98）和最高饮酒类别（与 1-4 单位/月相比，≥4 单位/天的危险比为 1.11；95%置信区间为 0.68-1.84）风险较高。自我报告和 EtG 均与全因死亡率无关。
自我报告和 EtG 与 CVD 事件和全因死亡率的相关性相当。这证明了在流行病学研究中自我报告饮酒量的有效性。
