School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK.
The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.
Clin Nutr. 2022 Feb;41(2):348-355. doi: 10.1016/j.clnu.2021.12.009. Epub 2021 Dec 14.
BACKGROUND & AIMS: To investigate potential biases that exist in available epidemiological evidence resulting in negative associations or underestimation of cardiovascular (CV) risk associated with alcohol consumption.
UK Biobank involved baseline data collection from 22 assessment centres across the United Kingdom. The cohort consisted of 333 259 alcohol consumers and 21 710 never drinkers. Participants were followed up for a median 6.9 years capturing incident fatal and non-fatal CV events, ischemic heart disease and cerebrovascular disease. Alcohol intake was reported as grams/week.
Using never drinkers as reference, alcohol from all drink types combined (hazard ratios ranging between 0.61 and 0.74), beer/cider (0.70-0.80) and spirits combined, and all wines combined (0.66-0.77) associated with a reduced risk for all outcome measures (all CV events, ischaemic heart disease, cerebrovascular disease). In continuous analysis, alcohol captured from all drink types combined (hazard ratio, 1.08, 95% confidence interval, 1.01-1.14), and beer/cider and spirits combined (1.24, 1.17-1.31) associated with an increased risk for overall CV events, however hazard ratios were stronger for beer/cider and spirits (P < 0.0001). Wine associated with a reduced risk for overall CV events (0.92, 0.86-0.98) and ischemic heart disease (0.75, 0.67-0.84). This negative relationship with overall CV events was lost after excluding ischemic heart disease events (1.00, 0.93-1.08), while the positive association of alcohol captured from beer/cider and spirits remained significant (1.30, 1.22-1.40). This positive association with overall CV events was present even when consuming less than 14 units per week.
Avoiding potential biases prevents underestimation of cardiovascular risk and indicates that consuming up to 14 units per week also associated with increased CV risk in the general population.
本研究旨在探讨现有的流行病学证据中可能存在的潜在偏倚，这些偏倚导致与饮酒相关的心血管（CV）风险呈负相关或被低估。
英国生物库（UK Biobank）在英国的 22 个评估中心进行了基线数据收集。该队列包括 333259 名饮酒者和 21710 名从不饮酒者。中位随访 6.9 年，以记录致命和非致命性 CV 事件、缺血性心脏病和脑血管疾病的发生情况。酒精摄入量以每周克数报告。
以从不饮酒者为参照，所有饮酒类型（危险比范围为 0.61 至 0.74）、啤酒/苹果酒（0.70-0.80）和烈酒的组合以及所有葡萄酒的组合（0.66-0.77）与所有结局指标（所有 CV 事件、缺血性心脏病、脑血管疾病）的风险降低相关。在连续分析中，所有饮酒类型的酒精摄入（危险比，1.08，95%置信区间，1.01-1.14）以及啤酒/苹果酒和烈酒的组合（1.24，1.17-1.31）与整体 CV 事件风险增加相关，但啤酒/苹果酒和烈酒的危险比更强（P<0.0001）。葡萄酒与整体 CV 事件（0.92，0.86-0.98）和缺血性心脏病（0.75，0.67-0.84）的风险降低相关。在排除缺血性心脏病事件后，这种与整体 CV 事件的负相关关系消失（1.00，0.93-1.08），而啤酒/苹果酒和烈酒中酒精摄入的正相关关系仍然显著（1.30，1.22-1.40）。即使每周饮酒量少于 14 单位，这种与整体 CV 事件的正相关关系仍然存在。
避免潜在偏倚可防止对心血管风险的低估，并表明在普通人群中，每周饮酒量高达 14 单位也与 CV 风险增加相关。
