The association between alcohol use and health is complex, with reports of both beneficial and harmful effects depending on the type and consumption levels. Accordingly, Andrew Smyth and colleagues show in a study published in The Lancet that current alcohol use is associated with a reduced rate of myocardial infarction (MI), but also with increased rates of alcohol-related cancer and injuries. Many studies have shown the association between low alcohol consumption and reduced risk of cardiovascular events, but Smyth notes the novel aspect of this study “is the inclusion of a significant number of participants from low-middle and low-income countries”.
The study involved 114,970 individuals from 12 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. The investigators divided the countries into income groups based on the World Bank classification at the time of enrolment. Alcohol intake was self-reported and 'never drinkers' (65% of all individuals) were used as the reference. The outcomes included cardiovascular disease, alcohol-related cancer, injury, and mortality, and data were adjusted for factors that included age, sex, medications, and hypertension. The analysis showed that current drinking (31%) was associated with a reduced risk of MI (HR 0.76, 95% CI 0.63–0.93), but an increased risk of alcohol-related cancers (HR 1.51, 95% CI 1.22–1.89) and injuries (HR 1.29, 95% CI 1.04–1.61). Only high alcohol intake was associated with increased mortality (HR 1.31, 95% CI 1.04–1.66). When stratified by income, current alcohol use was associated with a reduced risk of MI only in higher-income countries (HR 0.53, 95% CI 0.40–0.73).
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