Moderate drinking is associated with a lower risk of initial presentation of some forms of cardiovascular disease, according to a study in the BMJ.  

Researchers also found that a high level of alcohol consumption increases the initial potential for 12 cardiovascular diseases, including unheralded death from coronary heart disease, heart failure, and cardiac arrest/sudden coronary death.

Steven Bell, from the University of Cambridge in the UK, and colleagues investigated the association between alcohol consumption and cardiovascular disease at higher resolution by examining the initial lifetime presentation of 12 cardiac, cerebrovascular, abdominal, or peripheral vascular diseases. The investigators conducted a population-based cohort study of linked electronic health records (CALIBER) covering primary care, hospital admissions, and mortality from 1997 to 2010 with a median follow-up of 6 years. A total of 1,937,360 anonymous patients were included if they were older than age 30 years from January 1, 1997, to March 25, 2010, and had no record indicating any cardiovascular disease before study entry.

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To classify participants’ drinking behavior, the researchers used the most recent record of alcohol consumption in the 5 years before entry into the study. They developed 5 categories of drinking: non-drinking, former drinkers, occasional drinkers, current moderate drinkers, and heavy drinkers.

Patients were followed up until the date of an initial presentation of 1 of the cardiovascular end points (or death from non-cardiovascular causes) or were censored on the date they left the practice or the date of last data submission from their practice. The primary end points were 12 common symptomatic manifestations of cardiovascular disease, including chronic stable angina, unstable angina, acute myocardial infarction, unheralded coronary heart disease death, heart failure, sudden coronary death/cardiac arrest, transient ischemic attack, ischemic stroke, intracerebral and subarachnoid hemorrhage, peripheral arterial disease, and abdominal aortic aneurism.

A total of 114,859 patients received an incident cardiovascular diagnosis during follow-up. Non-drinking was associated with an increased risk of unstable angina (hazard ratio [HR], 1.33), myocardial infarction (HR, 1.32), unheralded coronary death (HR, 1.56), heart failure (HR, 1.24), ischemic stroke (HR, 1.12), peripheral arterial disease (HR, 1.22), and abdominal aortic aneurism (HR, 1.32), compared with moderate drinking. Heavy drinking conferred an increased risk of presenting with unheralded coronary death (HR, 1.21), heart failure (HR, 1.22), intracerebral hemorrhage (HR, 1.37), and peripheral arterial disease (HR, 1.35), but a lower risk of myocardial infarction (HR, 0.88) or stable angina (HR, 0.93).

“Our findings for aggregated end points are in line with those of previous observational studies, showing that there is an increased risk of coronary heart disease, cardiovascular disease, and all cause mortality in the group of non-drinkers from whom former and occasional drinkers have been removed,” said the authors. “At the same time, compared with moderate drinkers, heavy drinkers have an increased risk of experiencing all but coronary heart disease.”


  1. Bell S, Daskalopoulou M, Rapsomaniki E, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 22 March 2017. doi: 10.1136/bmj.j909