Table 2 Strength of the evidence for the relationship between alcohol consumption and ischemic heart disease

From: A burden of proof study on alcohol consumption and ischemic heart disease

 

RR (95% UI) at select exposure levels

Nadir exposure level

RR (95% UI) at nadir

85th percentile risk level

RR (95% UI) at 85th percentile risk level

Exposure-averaged BPRF

Conservative interpretation of the average risk increase/ decrease

ROS

Star rating

Pub. bias

No. of studies

10 g/day

30 g/day

50 g/day

Ischemic heart disease

0.76 (0.57, 1.01)

0.70 (0.48, 1.01)

0.73 (0.53, 1.01)

23 g/day

0.69 (0.48, 1.01)

45 g/day

0.72 (0.51, 1.01)

0.96

4%

0.04

Yes

122

 Morbidity

0.76 (0.51, 1.14)

0.66 (0.36, 1.22)

0.71 (0.42, 1.18)

26 g/day

0.66 (0.36, 1.22)

45 g/day

0.70 (0.41, 1.19)

1.08

N/A

−0.08

No

37

  Females

0.77 (0.56, 1.04)

0.81 (0.64, 1.03)

0.86 (0.72, 1.02)

15 g/day

0.74 (0.53, 1.05)

26 g/day

0.79 (0.61, 1.04)

0.99

1%

0.01

No

6

  Males

0.63 (0.44, 0.91)

0.58 (0.38, 0.89)

0.73 (0.58, 0.93)

20 g/day

0.54 (0.33, 0.87)

55 g/day

0.76 (0.61, 0.94)

0.86

14%

0.15

Yes

6

 Mortality

0.81 (0.55, 1.21)

0.74 (0.42, 1.31)

0.79 (0.51, 1.23)

25 g/day

0.74 (0.42, 1.32)

50 g/day

0.79 (0.51, 1.23)

1.16

N/A

−0.14

Yes

44

  Females

0.86 (0.55, 1.33)

0.83 (0.48, 1.42)

0.86 (0.56, 1.32)

20 g/day

0.81 (0.44, 1.48)

34 g/day

0.84 (0.50, 1.39)

1.25

N/A

−0.22

Yes

8

  Males

0.76 (0.64, 0.91)

0.74 (0.61, 0.90)

0.87 (0.80, 0.95)

19 g/day

0.70 (0.56, 0.88)

58 g/day

0.91 (0.85, 0.96)

0.90

10%

0.11

No

8

 Case-control studies

0.76 (0.64, 0.90)

0.68 (0.53, 0.86)

0.91 (0.85, 0.96)

23 g/day

0.65 (0.50, 0.85)

45 g/day

0.85 (0.77, 0.94)

0.87

13%

0.14

No

27

 Cohort studies

0.76 (0.58, 1.00)

0.69 (0.47, 1.01)

0.72 (0.52, 1.00)

23 g/day

0.69 (0.47, 1.01)

50 g/day

0.72 (0.52, 1.00)

0.95

5%

0.05

Yes

95

 Mendelian randomization studies

1.00 (0.62, 1.61)

1.00 (0.30, 3.38)

N/A

0 g/day

N/A

24 g/day

1.00 (0.36, 2.81)

N/A

N/A

N/A

 

No

4

Myocardial infarction

0.68 (0.49, 0.97)

0.69 (0.49, 0.97)

0.73 (0.54, 0.97)

15 g/day

0.66 (0.45, 0.96)

50 g/day

0.73 (0.54, 0.97)

0.92

8%

0.08

No

45

 Morbidity

0.65 (0.49, 0.87)

0.69 (0.54, 0.88)

0.80 (0.68, 0.93)

15 g/day

0.62 (0.45, 0.85)

49 g/day

0.79 (0.68, 0.92)

0.86

14%

0.2

Yes

24

 Mortality

0.86 (0.52, 1.41)

0.76 (0.32, 1.83)

0.75 (0.29, 1.92)

84 g/day

0.73 (0.26, 2.03)

61 g/day

0.74 (0.28, 1.96)

1.50

N/A

−0.4

No

9

  1. The reported relative risk (RR) and its 95% uncertainty interval (UI) reflect the risk an individual who has been exposed to alcohol consumption has of developing ischemic heart disease or myocardial infarction relative to that of someone who does not drink alcohol (i.e., has zero intake). We report the 95% UI that incorporates unexplained between-study heterogeneity. The Burden of Proof Risk Function (BPRF) is calculated for risk-outcome pairs that were found to have significant relationships at a 0.05 level of significance when not incorporating between-study heterogeneity in the 95% UI. The BPRF corresponds to the 5th or 95th quantile estimate of relative risk accounting for between-study heterogeneity closest to the null for each relationship, and it reflects a conservative estimate of excess risk or risk reduction associated with alcohol consumption that is consistent with the available data. Since we define alcohol consumption as a continuous risk factor, the risk-outcome score (ROS) is calculated as the signed value of the log RR of the BPRF averaged between the 15th and 85th percentiles of exposure levels observed across studies. Negative ROSs indicate that the evidence of the association is weak and inconsistent. For ease of interpretation, we have transformed the ROS and BPRF into a star rating (1–5) with a higher rating representing a larger effect with stronger evidence. The potential existence of publication bias, which, if present, would affect the validity of the results, was tested using Egger’s regression. Included studies represent all available relevant data identified through our systematic reviews from January 1970 through December 2021. N/A not available.
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