@article{3179935,
    title = "Alcohol intake in relation to non-fatal and fatal coronary heart disease
and stroke: EPIC-CVD case-cohort study",
    author = "Ricci, Cristian and Wood, Angela and Muller, David and Gunter, Marc J. and and Agudo, Antonio and Boeing, Heiner and van der Schouw, Yvonne T. and and Warnakula, Samantha and Saieva, Calogero and Spijkerman, Annemieke and and Sluijs, Ivonne and Tjonneland, Anne and Kyro, Cecilie and Weiderpass, and Elisabete and Kuehn, Tilman and Kaaks, Rudolf and Sanchez, Maria-Jose and and Panico, Salvatore and Agnoli, Claudia and Palli, Domenico and and Tumino, Rosario and Engstrom, Gunnar and Melander, Olle and Bonnet, and Fabrice and Boer, Jolanda M. A. and Key, Timothy J. and Travis, Ruth C. and and Overvad, Kim and Verschuren, W. M. Monique and Quiros, J. Ramon and and Trichopoulou, Antonia and Papatesta, Eleni-Maria and Peppa, Eleni and and Iribas, Conchi Moreno and Gavrila, Diana and Forslund, Ann-Sofie and and Jansson, Jan-Hakan and Matullo, Giuseppe and Arriola, Larraitz and and Freisling, Heinz and Lassale, Camille and Tzoulaki, Ioanna and Sharp, and Stephen J. and Forouhi, Nita G. and Langenberg, Claudia and Saracci, and Rodolfo and Sweeting, Michael and Brennan, Paul and Butterworth, Adam S. and and Riboli, Elio and Wareham, Nick J. and Danesh, John and Ferrari, and Pietro",
    journal = "BMJ (British Medical Journal)",
    year = "2018",
    volume = "361",
    publisher = "BMJ Publishing Group",
    issn = "0959-8138, 1756-1833",
    doi = "10.1136/bmj.k934",
    abstract = "OBJECTIVE To investigate the association between alcohol consumption (at
baseline and over lifetime) and non-fatal and fatal coronary heart
disease (CHD) and stroke.
DESIGN Multicentre case-cohort study.
SETTING A study of cardiovascular disease (CVD) determinants within the
European Prospective Investigation into Cancer and nutrition cohort
(EPIC-CVD) from eight European countries.
PARTICIPANTS 32 549 participants without baseline CVD, comprised of
incident CVD cases and a subcohort for comparison.
MAIN OUTCOME MEASURES Non-fatal and fatal CHD and stroke (including
ischaemic and haemorrhagic stroke).
RESULTS There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855
non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was
inversely associated with non-fatal CHD, with a hazard ratio of 0.94
(95% confidence interval 0.92 to 0.96) per 12 g/day higher intake.
There was a J shaped association between baseline alcohol intake and
risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65
(0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day,
15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake,
respectively, compared with 0.1-4.9 g/ day. In contrast, hazard ratios
for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05
(0.98 to 1.13) per 12 g/day increase in baseline alcohol intake,
respectively, including broadly similar findings for ischaemic and
haemorrhagic stroke. Associations with cardiovascular outcomes were
broadly similar with average lifetime alcohol consumption as for
baseline alcohol intake, and across the eight countries studied. There
was no strong evidence for interactions of alcohol consumption with
smoking status on the risk of CVD events.
CONCLUSIONS Alcohol intake was inversely associated with non-fatal CHD
risk but positively associated with the risk of different stroke
subtypes. This highlights the opposing associations of alcohol intake
with different CVD types and strengthens the evidence for policies to
reduce alcohol consumption."
}