Alcohol consumption and the risk of incident pulmonary embolism in US women and men

Abstract

Background Moderate alcohol consumption has been variably associated with hemostatic and fibrinolytic factor levels, but the association between alcohol consumption and the risk of incident pulmonary embolism (PE) remains uncertain. Objective To evaluate alcohol consumption amount and frequency in relation to PE risk. Methods Nurses' Health Study (NHS), NHS II and Health Professionals Follow-Up Study participants free of venous thromboembolism (VTE) at baseline (n = 217 442) reported alcohol consumption by type, quantity and frequency, every 2-4 years. Incident PE cases were identified by self-report and confirmed for participants without cancer. In this cohort study, we used Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) for PE associated with alcohol consumption amount and, separately, frequency. Secondary analyses evaluated alcohol type and heavy episodic drinking in relation to PE risk, and amount and frequency in relation to medical record-confirmed idiopathic PE and any self-reported VTE risk. Cohort-specific analyses were pooled using random-effects meta-analysis. Results During ≥ 20 years of follow-up, we identified 1939 PE events. We found no strong evidence of an association between PE risk and alcohol consumption amount (pooled HR for 5.0-14.9 g day vs. abstention = 0.97 [95% CI, 0.79, 1.20]) or frequency (pooled HR for 5-7 drinking days per week vs. abstention = 1.04 [95% CI, 0.88, 1.23]). Secondary analyses of type, heavy episodic drinking, idiopathic PE and VTE also yielded null findings. Conclusions Among three large prospective cohorts of US men and women, we found no evidence of an association between the amount or frequency of alcohol consumption and PE risk.

Alcohol Consumption and Risk of First-Time Venous Thromboembolism in Men and Women

“…Two population-based studies from Denmark and studies of male American health care workers found no association between alcohol consumption and VTE in men. 14,[16][17][18] In two of these studies, exposure to alcohol was substantially higher than in our population, making comparison between our study and those studies difficult. 14,17 As shown in ►Supplementary Table S2 (available in the online version), placing teetotallers in a separate category did not change our results regarding the association between alcohol consumption and risk of VTE in men.…”

“…The prospective population-based American Atherosclerosis Risk in Communities study showed an association between alcohol intake and VTE, but the analysis was not stratified by sex. 10 Other prospective studies have not shown an association between alcohol intake and risk of VTE, 13,14 or have shown an inverse association in the elderly. 8 We found an association between alcohol consumption and VTE in men.…”

“…Previous studies have shown a link between alcohol intake and either lower, 8,9 or higher 10 risk of VTE, or no link between the two. [11][12][13][14] Men and women differ in drinking habits, which may affect a possible association between alcohol intake and VTE. Women are, in general, more often teetotallers, drink less frequently and are less likely to have an excessive alcohol consumption.…”

“…15 Studies reporting risk of VTE in men separately showed no association between alcohol consumption and risk of VTE, 9,14,[16][17][18] whereas those reporting VTE risk in women showed either a decreased risk of VTE associated with alcohol intake 9,19,20 or no association. 14,17,18,21 To our knowledge there are no studies of the association between alcohol dependence and VTE, but one study has shown an association between alcohol use disorders and VTE. 22 Our hypothesis was that there was an association between alcohol consumption, alcohol dependence and increased risk of VTE in both men and women.…”

Cardiovascular Risk Factors Associated With Venous Thromboembolism

“…We also noted a pattern of association between alcohol consumption and VTE similar to that reported in previous studies of alcohol consumption and nonfatal myocardial infarction. 32,37,38 (By contrast, alcohol consumption has previously been positively associated with risks of fatal coronary disease, stroke, and heart failure.) Although previous studies have reported that moderate alcohol consumption is associated with lower levels of hemostatic factors (eg, fibrinogen, factor VII, and von Willebrand factor), 39,40 further studies are needed to determine whether moderate alcohol consumption has a causal role in VTE.…”