Page last updated: Tuesday, November 18, 2008
J-shaped Curve for All Cause Mortality for Moderate Drinkers Confirmed by Comprehensive 23 year Study
The new year has seen a rush of new research being published on alcohol and health, the most important referring to the elderly and to heart disease and all cause mortality

A comprehensive paper by Doll R, Peto R et al. Mortality in relation to alcohol consumption: a prospective study among male British doctors, published in International J Epidemiol 2005;34:199–204 related alcohol consumption patterns to mortality in an elderly population of 12,000 male British doctors over 23-years. The candidates were aged between 48–78 years in 1978.

As expected, vascular disease and respiratory disease accounted for more than half of all the deaths and were both significantly less common among current than among non-drinkers; hence, overall mortality was also significantly lower (RR = 0.81, CI 0.76–0.87, P = 0.001) The authors conclude that although some of the apparently protective effect of alcohol against disease is artefactual, some of it is real.

The British physicians consumed an average of 2-3 British units/day (1 ½ to 2 US drinks per day). There had been 7,000 deaths by the time of the survey and, as in earlier reports from this study, the physicians who were moderate drinkers had lower death rates.

For the latter part of their observational period, the authors had data on the amount of alcohol consumed, and found the lowest risk of ischemic heart disease death at 15-28 units/week (about 10-18 US “drinks”/week) and for total mortality at 8-14 units/week. This is in line with UK and US sensible drinking guidelines, although these results may differ for a female population (see analysis on page 6 & 8).

Mortality risks for ex-drinkers differed according to when they quit, with long-term ex-drinkers having the same risk as life-time abstainers and recent ex-drinkers having risks even higher than current drinkers.

In the table, the points of alcohol consumption are the mean values of each category (4.4, 11.5, 21.2, and 41.5 units/week, respectively). Deaths from ischemic heart disease, respiratory disease, and total mortality were significantly lower among the moderate drinkers.

In the study, the causes of death that are already known to be augmentable by alcohol accounted for 5% of the deaths (1% liver disease, 2% cancer of the mouth, pharynx, larynx, or esophagus, and 2% external causes of death) and occurred among men consuming well above > 2 units/day.

Room R et al. of Stockholm University in Sweden, in an article ‘Alcohol and Public Health’ published in The Lancet (2005;365:519-30) concentrates on that percentage stating that alcohol ‘is linked to more than 60 different medical conditions, including oral, liver and breast cancers, heart disease, stroke and cirrhosis. It also increases the risk of car accidents, drowning, falls and homicides. “Overall, 4 percent of the global burden of disease is attributable to alcohol, which accounts for about as much death and disability globally as tobacco and hypertension,” said Professor Robin Room of Stockholm University in Sweden.

Room calls for a 10% rise in taxes in a bid to reduce per capita consumption rather than targeted approaches to help dependent drinkers, or to counter binge drinking.

In an altogether more balanced approach La Vecchia C et al assess the risk/benefit of lower cardiovascular disease against the increased risk of cancer from heavy drinking (Wine, alcohol and disease:less cardiovascular disease, more cancer? J Thromb Haemost 2004;2:2045–2046).

The authors conducted a meta-analysis of 156 papers on 15 alcohol-related conditions, including a total of 116,706 cases. Heavy alcohol drinking was strongly related to the diseases considered: the model-based relative risk (RR) estimates for an intake of 100 g of ethanol per day (about 8 typical “drinks”) were 6.4 for cancer of the oral cancer and pharynx, 3.6 of the esophagus, 3.8 of the larynx, 1.2 of the colon, 1.4 of the rectum, 1.8 of the liver, and 2.4 of the breast.

For non-neoplastic conditions, corresponding RR estimates for 100 g/day were 4.2 for essential hypertension, 1.1 for coronary heart disease, 4.4 for ischemic stroke, 4.1 for hemorrhagic stroke, 26.5 for cirrhosis, 3.2 for chronic pancreatitis, and 1.6 for injury and violence. For < 25 g/day (about 2 typical drinks), the analyses showed risk ratios less than 1.0 for coronary heart disease, ischemic stroke, and gastro-duodenal ulcer.

The authors conclude that the unfavourable effects of heavy alcohol drinking on health are clearly established. It describes the increases in the relative risk of a number of cancers and other conditions associated with the consumption of 100 g/day (sensible drinking guidelines vary from country to country between 14g and 24g for women and 24 –32g/day for men). The paper emphasized the need for more research on a clear cut off point at which point drinking becomes ‘hazardous for health’.

As ever, the moderation message is clearly confirmed by Doll and La Vecchia; the consumption of alcohol at levels within sensible drinking guidelines reduces your risk of overall mortality.

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