Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up

BMJ 1999;318:1725-1729 ( 26 June )

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Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of follow up

Carole L Hart, research fellow, ^a George Davey Smith, professor of clinical epidemiology, ^b David J Hole, principal epidemiologist, ^c Victor M Hawthorne, professor of epidemiology. ^d

^a Department of Public Health, University of Glasgow, Glasgow G12 8RZ, ^b Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^c West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow G12 8RZ, ^d University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, USA

Correspondence to: Professor Davey Smith zetkin{at}bristol.ac.uk

Objectives: To relate alcohol consumption tomortality.
Design: Prospective cohortstudy.
Setting: 27 workplaces in the west ofScotland.
Participants: 5766 men aged 35-64 when screened in 1970-3who answered questions on their usual weekly alcoholconsumption.
Main outcome measures: Mortality from all causes, coronary heartdisease, stroke, and alcohol related causes over 21 years of followup related to units of alcohol consumed perweek.
Results: Risk for all cause mortality was similar fornon-drinkers and men drinking up to 14 units a week. Mortalityrisk then showed a graded association with alcohol consumption(relative rate compared with non-drinkers 1.34 (95% confidenceinterval 1.14 to 1.58) for 15-21 units a week, 1.49 (1.27 to 1.75)for 22-34 units, 1.74 (1.47 to 2.06) for 35 or more units). Adjustmentfor risk factors attenuated the increased relative risks, butthey remained significantly above 1 for men drinking 22 or moreunits a week. There was no strong relation between alcohol consumptionand mortality from coronary heart disease after adjustment. Astrong positive relation was seen between alcohol consumptionand risk of mortality from stroke, with men drinking 35 or moreunits having double the risk of non-drinkers, even afteradjustment.
Conclusions: The overall association between alcohol consumptionand mortality is unfavourable for men drinking over 22 units aweek, and there is no clear evidence of any protective effectfor men drinking less thanthis.

Key messages

Results from a large cohort study of employed Scottish men showed different relations between alcohol consumption and mortality than previous studies
There was no relation between mortality from coronary heart disease and alcohol consumption once adjustments were made for potential confounding factors
There was a strong relation with mortality from stroke; drinkers of over 35 units a week had double the risk of mortality compared with non-drinkers
Some but not all of this could be accounted for by alcohol related increases in blood pressure
Overall, risk of all cause mortality was higher in men drinking 22 or more units a week

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