Drinking alcohol above daily recommended limit shortens life

Organisation: Position: Deadline Date: Location:

Drinking alcohol will shorten your life. Research in the United Kingdom suggests that every glass of wine or pint of beer over the daily recommended limit will cut half an hour from the expected lifespan of a 40-year-old, reports The Guardian. Alcohol consumption was also associated with a higher risk of stroke, fatal aortic aneurysms, fatal hypertensive disease and heart failure.

The study was undertaken by researchers at the Emerging Risk Factors/UK Biobank Alcohol Study group collaboration and led by Angela M Wood of the department of public health and primary care at the University of Cambridge.

Those who think a glass of red wine every evening will help keep the heart healthy will be dismayed. The paper says five standard 175ml glasses of wine or five pints a week is the upper safe limit – about 100g of alcohol, or 12.5 units in total. More than that raises the risk of stroke, fatal aneurysm (a ruptured artery in the chest), heart failure and death.

The risks for a 40-year-old of drinking over the recommended daily limit were comparable to smoking, said one leading scientist. “Above two units a day, the death rates steadily climb,” said David Spiegelhalter, Winton professor for the public understanding of risk at the University of Cambridge.

“The paper estimates a 40-year-old drinking four units a day above the guidelines (the equivalent of drinking three glasses of wine in a night) has roughly two years’ lower life expectancy, which is around a 20th of their remaining life. This works out at about an hour per day. So, it’s as if each unit above guidelines is taking, on average, about 15 minutes of life, about the same as a cigarette. Of course, it’s up to individuals whether they think this is worthwhile.”

The report says there is still a small benefit to drinking, which has been much flagged in the past. It does reduce the chance of a non-fatal heart attack. But, said Wood, “this must be balanced against the higher risk associated with other serious – and potentially fatal – cardiovascular diseases.”

The big international study supports the new UK recommended limits of a maximum of 14 units a week for both men and women, which were fiercely contested when introduced by England’s chief medical officer, Dame Sally Davies, in 2016. Other countries with higher limits should reduce them, it suggests. They include Italy, Portugal and Spain as well as the US, where for men the recommended limit is almost double.

The report says the study included data from nearly 600,000 current drinkers included in 83 studies carried out in 19 countries. About half the participants reported drinking more than 100g per week, and 8.4% drank more than 350g per week. Early deaths rose when more than 100g per week, which is five to six glasses of wine or pints of beer, was consumed.

A 40-year-old who drank up to twice that amount (100 to 200g) cut their life expectancy by six months. Between 200g and 350g a week, they lost one to two years of life, and those who drank more than 350g a week shortened their lives by four to five years.

Tim Chico, professor of cardiovascular medicine at the University of Sheffield, said smokers lost on average 10 years of life. “However, we think from previous evidence that it is likely that people drinking a lot more than 43 units are likely to lose even more life expectancy, and I would not be surprised if the heaviest drinkers lost as many years of life as a smoker. This study makes clear that on balance there are no health benefits from drinking alcohol, which is usually the case when things sound too good to be true.”

Spiegelhalter said it was “a massive and very impressive study. It estimates that, compared to those who only drink a little, people who drink at the current UK guidelines suffer no overall harm in terms of death rates, and have 20% fewer heart attacks.”

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, which part-funded the study, called it “a serious wakeup call for many countries.”

Dr Tony Rao, visiting lecturer in old age psychiatry at King’s College London, said the study “highlights the need to reduce alcohol related harm in baby boomers, an age group currently at highest risk of rising alcohol misuse”. It did not take into account the possibility of mental disorders such as dementia, which could accompany the other health problems drinkers incur.

In a commentary, Professors Jason Connor and Wayne Hall from the University of Queensland Centre for Youth Substance Abuse Research in Australia, anticipated that the suggestion of lowering recommended drinking limits will come up against opposition.

“The drinking levels recommended in this study will no doubt be described as implausible and impracticable by the alcohol industry and other opponents of public health warnings on alcohol. Nonetheless, the findings ought to be widely disseminated and they should provoke informed public and professional debate.”

Summary
Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.
Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th–95th percentile 1·04–13·5]) from 71 011 participants from 37 studies.
Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.
Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

Authors
Emerging Risk Factors/UK Biobank Alcohol Study group

 

The researchers also looked at the association between alcohol consumption and different types of cardiovascular disease. Alcohol consumption was associated with a higher risk of stroke, heart failure, fatal aortic aneurysms, and fatal hypertensive disease and heart failure and there were no clear thresholds where drinking less did not have a benefit.

By contrast, alcohol consumption was associated with a slightly lower risk of non-fatal heart attacks.

The authors note that the different relationships between alcohol intake and various types of cardiovascular disease may relate to alcohol’s elevating effects on blood pressure and on factors related to elevated high-density lipoprotein cholesterol (HDL-C) (also known as ‘good’ cholesterol). They stress that the lower risk of non-fatal heart attack must be considered in the context of the increased risk of several other serious and often fatal cardiovascular diseases.

The study focused on current drinkers to reduce the risk of bias caused by those who abstain from alcohol due to poor health. However, the study used self-reported alcohol consumption and relied on observational data, so no firm conclusions can me made about cause and effect. The study did not look at the effect of alcohol consumption over the life-course or account for people who may have reduced their consumption due to health complications.

Wood said: “If you already drink alcohol, drinking less may help you live longer and lower your risk of several cardiovascular conditions.

“Alcohol consumption is associated with a slightly lower risk of non-fatal heart attacks but this must be balanced against the higher risk associated with other serious – and potentially fatal – cardiovascular diseases.”

Victoria Taylor, senior dietician at the British Heart Foundation, which part-funded the study, said: “This powerful study may make sobering reading for countries that have set their recommendations at higher levels than the UK, but this does seem to broadly reinforce government guidelines for the UK.

“This doesn’t mean we should rest on our laurels, many people in the UK regularly drink over what’s recommended. We should always remember that alcohol guidelines should act as a limit, not a target, and try to drink well below this threshold.”

The study was funded by the UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.

The Guardian report
University of Cambridge material
The Lancet article summary
www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext
The Lancet comment


Receive Medical Brief's free weekly e-newsletter



Related Posts

Thank you for subscribing to MedicalBrief


MedicalBrief is Africa’s premier medical news and research weekly newsletter. MedicalBrief is published every Thursday and delivered free of charge by email to over 33 000 health professionals.

Please consider completing the form below. The information you supply is optional and will only be used to compile a demographic profile of our subscribers. Your personal details will never be shared with a third party.


Thank you for taking the time to complete the form.