Cardiovascular
Effect of sustained alcohol abstinence versus moderate consumption of wine on cardiovascular disease: emulating a target trial using data from NHS and HPFS Shuyuan Yang* Shuyuan Yang Eric Rimm Kenneth Mukamal Edward Giovannucci Dalia Stern Miguel A. Martínez-González Yu-Han Chiu
Background: Numerous observational studies have reported a “J-shaped” relationship between alcohol consumption and cardiovascular disease, while only a few recent non-original studies have supported complete abstention as the best cardio-preventive strategy. However, all these comparisons lack actionable guidance for decision-making regarding the best advice to be given to drinkers. This study addressed this gap by emulating a target trial to assess the effect of quitting versus maintaining moderating wine consumption among baseline drinkers.
Methods: Using biennially collected data from Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS), we identified men (50-70 years old) or women (55-75 years) consuming ≥3 but ≤40 servings/wk of any alcoholic beverage and without prior history of liver or breast cancer at baseline. We compared two sustained strategies: 1) complete abstention from any alcoholic beverage, and 2) moderation with wine, limiting it to no more than 14 servings/wk for males and 7 servings/wk for females, with no more than one serving/wk of other alcoholic beverages. The primary outcome was the 12-year risk of major atherosclerotic cardiovascular events (MACE), defined as a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. We used the parametric g-formula to estimate MACE risk under these interventions.
Results: Of the 24,753 participants who met the eligibility criteria, 2,852 had MACE during follow-up. The estimated 12-year risks of MACE were 12.7% under abstention versus 11.4% under moderation with wine in the NHS (RD = -1.3%, 95% CI: -1.9% to -0.9%), and 20.5% versus 18.8% in the HPFS (RD = -1.7%, 95% CI: -2.8% to -0.8%). The corresponding risk ratios were 0.89 (95% CI: 0.86-0.93) in the NHS and 0.92 (95% CI: 0.87-0.96) in the HPFS.
Conclusions: We estimated that drinkers remaining moderate consumers of wine may have a slightly lower risk of MACE than those who abstain completely.