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Carr S, Bryazka D, McLaughlin SA, Zheng P, Bahadursingh S, Aravkin AY, Hay SI, Lawlor HR, Mullany EC, Murray CJL, Nicholson SI, Rehm J, Roth GA, Sorensen RJD, Lewington S, Gakidou E. A burden of proof study on alcohol consumption and ischemic heart disease. Nat Commun 2024; 15:4082. [PMID: 38744810 PMCID: PMC11094064 DOI: 10.1038/s41467-024-47632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk - specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males - while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.
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Affiliation(s)
- Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Dana Bryazka
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sarasvati Bahadursingh
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hilary R Lawlor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sneha I Nicholson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sarah Lewington
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Lindbohm JV, Kaprio J, Jousilahti P, Salomaa V, Korja M. Sex, Smoking, and Risk for Subarachnoid Hemorrhage. Stroke 2016; 47:1975-81. [DOI: 10.1161/strokeaha.116.012957] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Women are at higher risk for subarachnoid hemorrhage (SAH) than men for unknown reasons. Also cumulative effects of smoking have been neglected among prospective studies. We studied associations between smoking habits and SAH and interactions between known SAH risk factors in a prospective population-based study.
Methods—
The population-based FINRISK study cohort of 65 521 individuals was followed up for 1.38 million person-years. We used the Cox proportional hazards model to calculate hazard ratios and evaluated additive and multiplicative interactions between study variables, with all analyses adjusted for known SAH risk factors.
Results—
During follow-up, we identified 492 SAHs (266 women). Smoking had a linear dose-dependent and cumulative association with risk for SAH in both sexes. Women smoking >20 cigarettes per day had a hazard ratio of 8.35 (95% confidence interval, 3.86–18.06) compared with a hazard ratio of 2.76 (95% confidence interval, 1.68–4.52) in men in the same cigarettes per day group. Hazard ratios differed by sex in all cigarettes per day and pack-year categories; this association was stronger in women in all categories (
P
=0.01). When an adjusted model included interaction terms between sex and cigarettes per day or pack-years, female sex was no longer an independent SAH risk factor. Former smokers had a markedly decreased risk for SAH in both sexes when compared with current smokers.
Conclusions—
Smoking has a dose-dependent and cumulative association with SAH risk, and this risk is highest in female heavy smokers. Vulnerability to smoking seems to explain in part the increased SAH risk in women.
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Affiliation(s)
- Joni Valdemar Lindbohm
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Jaakko Kaprio
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Pekka Jousilahti
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Veikko Salomaa
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
| | - Miikka Korja
- From the Department of Public Health, University of Helsinki, Helsinki, Finland (J.V.L., J.K.); Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (J.V.L., M.K.); National Institute for Health and Welfare, Helsinki, Finland (J.K.); and Institute for Molecular Medicine Finland, Helsinki, Finland (P.J., V.S.)
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