Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems

Abstract

The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in ‘no added’ risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.

Are there non-linear relationships between alcohol consumption and long-term health?: A systematic review of observational studies employing approaches to improve causal inference

“…However, few studies have employed these methods, with covariate-adjusted, conventional cohort analyses remaining dominant, preventing a conclusive picture of the nature of these relationships from emerging. Given that associations found between moderate alcohol consumption and good health impact safe drinking guidelines and public health policy (51,52), further research employing methods to mitigate confounding and other biases is urgently required to establish whether such findings are truly causal.…”

Methods for Estimating Avoidable Costs of Excessive Alcohol Consumption

“…Next, the authors stated that health benefits from moderate drinking should no longer play a role in decision making. Furthermore, Sherk et al [ 65 ] suggested a need of downward revisions to daily consumption levels, which would result in safe drinking with no added risks. On the contrary, many authors, such as Sacks et al [ 66 ], have considered the positive effects of drinking.…”

Are there non-linear relationships between alcohol consumption and long-term health?: Protocol for a systematic review of observational studies employing approaches to improve causal inference

“…This will be a novel perspective through which to examine the literature on whether moderate alcohol consumption is protective, focusing on those studies that best promote causal inference from observational research. The presumption that the associations found between moderate alcohol consumption and good health reflect a causal relationship significantly impacts burden of disease estimates, safe drinking guidelines and public health policy [44,45]. The importance of the proposed review will therefore lie in helping to establish whether such findings are truly causal.…”