Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease (CVD) and all-cause mortality compared with heavy alcohol use and abstaining. 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. A study published in April in the Journal of the American Heart Association examined and compared the associations of self-reported alcohol consumption and EtG with CVD and all-cause mortality.
In 5,676 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, analysed 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.
Comparable associations with CVD events and all-cause mortality were found for self-report and EtG. The researchers comment that this argues for the validity of self-reported alcohol consumption in epidemiologic research.
Source: van de Luitgaarden IAT, Schrieks IC, Kieneker LM, et al. Urinary Ethyl Glucuronide as Measure of Alcohol Consumption and Risk of Cardiovascular Disease: A Population-Based Cohort Study. J Am Heart Assoc. 2020;9(7):e014324. Journal of the American Heart Association.