Consumption of alcohol and cardiovascular disease mortality: a 16 year follow-up of 115,592 Norwegian men and women aged 40–44 years
We tested whether teetotalism explains the upturn in cardiovascular risk for non-drinkers and whether wine is a more favorable alcohol type. We studied 115,592 men and women aged 40–44 years who participated in the age 40 program in Norway in 1994–1999 and were followed for an average of 16 years with 550 cardiovascular deaths. Self-reported number of glasses of beer, wine and spirits during 14 days was transformed to alcohol units/day. One unit is approximately 8 grams of pure alcohol. The mean and median number of alcohol units/day were 0.70 and 0.46. Teetotallers had higher risk of dying from cardiovascular disease than alcohol consumers, multivariate adjusted hazard ratio (95% CI) 1.97 (1.52–2.56). The use of alcohol-related deaths as endpoint substantiated a selection of previous alcohol users to the teetotal group. Without teetotallers there was no association between alcohol consumption and cardiovascular disease mortality. However, the multivariate adjusted hazard ratio per one unit/day of wine was 0.76 (0.58–0.99). The corresponding figures for beer and spirits were 1.04 (0.94–1.15) and 0.98 (0.75–1.29). The upturn in risk for non-drinkers could be explained by a higher risk for teetotallers who likely included previous alcohol users or teetotalers who started to drink during follow-up. Wine gave the most favorable risk estimates.
KeywordsBeer Wine Spirits Risk factors
AT: study concept, design and drafting the manuscript. RS: acquisition of data, interpretation of data and critical revision of the article for important intellectual content and final approval of the article. All authors: interpretation of data and critical revision of the article for important intellectual content and final approval of the article.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by Regional Committees for Medical and Health Research Ethics and The Norwegian Data Protection Authority.
- 9.Roerecke M, Rehm J. Alcohol consumption, drinking pattern, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Med. 2014;12:182. doi: 10.1186/s12916-014-0182-6.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.StataCorp. Stata Statistical Software: release 13. College Station: StataCorp LP; 2013.Google Scholar
- 12.VanderWeele T. Explanation in causal inference: methods for mediation and interaction. Oxford: Oxford University Press; 2015. p. 249–85.Google Scholar
- 14.Norwegian Institute of Public Health. Alcohol and other psychoactive substances—Public Health Report 2014. https://www.fhi.no/en/online-publications/public-health-report-2014/risk–protective-factors/alcohol-and-other-psychoactive-subs/#international-comparison.
- 16.Dai J, Mukamal KJ, Krasnow RE, Swan GE, Reed T. Higher usual alcohol consumption was associated with a lower 41-y mortality risk from coronary artery disease in men independent of genetic and common environmental factors: the prospective NHLBI Twin Study. Am J Clin Nutr. 2015;102:31–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Tverdal A. Dødelighet av hjerteinfarkt i fylker og helseregioner i perioden 1951–1994. Norsk Epidemiologi. 1998;8(1):79–90.Google Scholar
- 18.Bjartveit K, Wøien G. Cardiovascular disease risk factors in Norway. Results from surveys in 18 counties. Oslo: National Health Screening Service; 1997.Google Scholar