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Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

BMJ 2011; 342 doi: (Published 22 February 2011) Cite this as: BMJ 2011;342:d671
  1. Paul E Ronksley, doctoral student1,
  2. Susan E Brien, postdoctoral fellow1,
  3. Barbara J Turner, professor of medicine and director2,
  4. Kenneth J Mukamal, associate professor of medicine3,
  5. William A Ghali, scientific director and professor14
  1. 1Calgary Institute for Population and Public Health, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Alberta, Canada T2N 4Z6
  2. 2REACH Center, University of Texas Health Science Center, San Antonio, TX, USA, and Health Outcomes Research, University Health System, San Antonio
  3. 3Harvard Medical School and Associate in Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
  4. 4Department of Medicine, Faculty of Medicine, University of Calgary
  1. Correspondence to: W Ghali wghali{at}
  • Accepted 12 December 2010


Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes.

Design Systematic review and meta-analysis.

Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings.

Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke.

Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis.

Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)).

Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.


  • Preliminary results from this manuscript were presented at the 32nd annual meeting of the Society of General Internal Medicine, Miami, Florida, 14 May 2009.

  • Contributors: All authors conceived the study and developed the protocol. PER and SEB conducted the search, abstracted the data for the analysis, and performed the statistical analysis. PER, SEB, and WAG wrote the first draft of the manuscript. All authors had access to the data, critically reviewed the manuscript for important intellectual content, and approved the final version of the manuscript. WAG will act as guarantor for the paper.

  • Funding: This work was supported by a contracted operating grant from Program of Research Integrating Substance Use Information into Mainstream Healthcare (PRISM) funded by the Robert Wood Johnson Foundation, project No 58529, with cofunding by the Substance Abuse and Mental Health Services and the Administration Center for Substance Abuse Treatment. PER is supported by a Frederick Banting and Charles Best Canada Graduate Scholarship from the Canadian Institutes of Health Research. SEB is supported by a Postdoctoral Fellowship Award from the Alberta Heritage Foundation for Medical Research. WAG is supported by a Canada Research Chair in Health Services Research and by a Senior Health Scholar Award from the Alberta Heritage Foundation for Medical Research. The study was conducted independently of funding agencies. None of the funding agencies played an active role in the preparation, review, or editing of this manuscript.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: support from the Robert Wood Johnson Foundation, the Substance Abuse and Mental Health Services, and the Administration Center for Substance Abuse Treatment (as detailed above) for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: Statistical code and datasets available from the corresponding author at

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