Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease.
Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease.
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DOI：
10.1001/jamanetworkopen.2022.3849
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发表时间：
2022-03-01
影响因子：
13.8
通讯作者：
Aragam KG
中科院分区：
文献类型：
--
作者：
Biddinger KJ;Emdin CA;Haas ME;Wang M;Hindy G;Ellinor PT;Kathiresan S;Khera AV;Aragam KG
心血管疾病的风险与不同的习惯性饮酒量有关吗？在这项对371463人进行的队列研究中，遗传证据支持所有饮酒量与高血压和冠状动脉疾病之间存在非线性的、持续的风险增加相关性，轻度饮酒的风险适度增加，而高水平饮酒的风险呈指数级增加。在这项研究中，所有水平的酒精消费都与心血管疾病风险增加有关，但围绕习惯性饮酒的临床和公共卫生指南应该考虑到不同酒精消费水平之间心血管风险的显著差异，即使是在目前的指南推荐限制范围内。这项队列研究评估了习惯性饮酒与心血管疾病风险之间的关系，并评估了与不同饮酒量相关的心血管风险的方向和相对大小。观察性研究一直提出与轻度饮酒相关的心血管益处，而最近的遗传分析（即孟德尔随机研究）表明酒精摄入与心血管疾病风险增加之间可能存在因果关系。然而，传统的遗传流行病学方法假设线性关联，因此没有充分评估不同酒精摄入水平的剂量反应风险估计。评估习惯性饮酒与心血管疾病风险的相关性，并评估与不同饮酒量相关的心血管风险的方向和相对大小。这项队列研究使用了英国生物银行（2006-2010年，随访至2016年），以检查酒精摄入和心血管疾病之间流行病学关联的混杂因素。使用传统（即线性）和非线性孟德尔随机化，酒精消费和心血管疾病（如高血压和冠状动脉疾病）之间的潜在关联以及相应的关联形状进行了评估。数据分析于二零一九年七月至二零二二年一月进行。酒精摄入的遗传倾向。饮酒与心血管疾病之间的关系，包括高血压、冠状动脉疾病、心肌梗死、中风、心力衰竭和心房纤颤。这项研究包括371463名参与者（平均[SD]年龄，57.0 [7.9]岁; 172400 [46%]名男性），他们每周平均（SD）消费9.2（10.6）标准饮料。总体而言，121708名参与者（33%）患有高血压。轻度至中度饮酒与健康的生活方式因素有关，调整后适度饮酒会减弱心脏保护流行病学相关性。在线性孟德尔随机分析中，遗传预测的饮酒量增加1-SD与高血压风险增加1.3倍（95%CI，1.2-1.4）（P <0.001）和冠状动脉疾病风险增加1.4倍（95%CI，1.1-1.8）（P = 0.006）相关。非线性孟德尔随机化分析表明，饮酒与高血压和冠状动脉疾病之间存在非线性相关性：少量饮酒与心血管风险的极轻微增加相关，而大量饮酒与临床和亚临床心血管疾病的风险呈指数级增加相关。在这项队列研究中，同时，有利的生活方式因素削弱了适度饮酒的观察益处。遗传流行病学表明，所有数量的酒精消费都与心血管风险增加有关，但不同摄入水平之间存在显著的风险差异，包括现行国家指南所接受的水平。
What is the risk of cardiovascular disease associated with different amounts of habitual alcohol consumption? In this cohort study of 371 463 individuals, genetic evidence supported a nonlinear, consistently risk-increasing association between all amounts of alcohol consumption and both hypertension and coronary artery disease, with modest increases in risk with light alcohol intake and exponentially greater risk increases at higher levels of consumption. In this study, alcohol consumption at all levels was associated with increased risk of cardiovascular disease, but clinical and public health guidance around habitual alcohol use should account for the considerable differences in cardiovascular risk across different levels of alcohol consumption, even those within current guideline-recommended limits. This cohort study assesses the association between habitual alcohol intake and cardiovascular disease risk and evaluates the direction and relative magnitude of cardiovascular risk associated with different amounts of alcohol consumption. Observational studies have consistently proposed cardiovascular benefits associated with light alcohol consumption, while recent genetic analyses (ie, mendelian randomization studies) have suggested a possible causal link between alcohol intake and increased risk of cardiovascular disease. However, traditional approaches to genetic epidemiology assume a linear association and thus have not fully evaluated dose-response estimates of risk across different levels of alcohol intake. To assess the association of habitual alcohol intake with cardiovascular disease risk and to evaluate the direction and relative magnitude of cardiovascular risk associated with different amounts of alcohol consumption. This cohort study used the UK Biobank (2006-2010, follow-up until 2016) to examine confounding in epidemiologic associations between alcohol intake and cardiovascular diseases. Using both traditional (ie, linear) and nonlinear mendelian randomization, potential associations between alcohol consumption and cardiovascular diseases (eg, hypertension and coronary artery disease) as well as corresponding association shapes were assessed. Data analysis was conducted from July 2019 to January 2022. Genetic predisposition to alcohol intake. The association between alcohol consumption and cardiovascular diseases, including hypertension, coronary artery disease, myocardial infarction, stroke, heart failure, and atrial fibrillation. This study included 371 463 participants (mean [SD] age, 57.0 [7.9] years; 172 400 [46%] men), who consumed a mean (SD) 9.2 (10.6) standard drinks per week. Overall, 121 708 participants (33%) had hypertension. Light to moderate alcohol consumption was associated with healthier lifestyle factors, adjustment for which attenuated the cardioprotective epidemiologic associations with modest intake. In linear mendelian randomization analyses, a 1-SD increase in genetically predicted alcohol consumption was associated with 1.3-fold (95% CI, 1.2-1.4) higher risk of hypertension (P < .001) and 1.4-fold (95% CI, 1.1-1.8) higher risk of coronary artery disease (P = .006). Nonlinear mendelian randomization analyses suggested nonlinear associations between alcohol consumption and both hypertension and coronary artery disease: light alcohol intake was associated with minimal increases in cardiovascular risk, whereas heavier consumption was associated with exponential increases in risk of both clinical and subclinical cardiovascular disease. In this cohort study, coincident, favorable lifestyle factors attenuated the observational benefits of modest alcohol intake. Genetic epidemiology suggested that alcohol consumption of all amounts was associated with increased cardiovascular risk, but marked risk differences exist across levels of intake, including those accepted by current national guidelines.
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DOI：
10.1016/s0140-6736(18)32203-7
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Causes of Death Collaborators
通讯作者：
GBD 2017 Causes of Death Collaborators
影响因子：
2.1
作者：
Staley JR;Burgess S
通讯作者：
Burgess S
影响因子：
2.9
作者：
Visontay R;Sunderland M;Slade T;Wilson J;Mewton L
通讯作者：
Mewton L
DOI：
10.1016/s0140-6736(18)32225-6
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Risk Factor Collaborators
通讯作者：
GBD 2017 Risk Factor Collaborators
影响因子：
37.8
作者：
Arvanitis M;Qi G;Bhatt DL;Post WS;Chatterjee N;Battle A;McEvoy JW
通讯作者：
McEvoy JW