论文标题：Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data
期刊：
作者：Dara O’Neill et al
发表时间： 2018/8/22
数字识别码：10.1186/s12916-018-1123-6
原文链接：
最近发表在BMC Medicine上的一项基于35,132人数据的研究发现，无规律的饮酒会让心血管疾病的风险升高，但符合健康指南推荐量、规律适度的饮酒却可能对心血管有保护作用。
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由伦敦大学学院和剑桥大学领衔的一个研究团队发现，在为期10年的时间里，与那些遵循英国适度饮酒指南规律饮酒的人相比，适度但不规律饮酒者、曾经饮酒但已经戒酒者和自我手机版中从不饮酒者罹患冠心病的风险更高，不过符合这一规律的不饮酒者仅限于女性。
来自伦敦大学学院的通讯作者Dara O’Neill博士说：“我们的研究会利用长期追踪数据来区分从不饮酒的人和曾经饮酒但已戒酒的人——按照广为接受的理论，后者患冠心病的风险应该比前者高，我们想通过数据检验一下是否如此。最后的结果的确证实了这个结论，但我们发现这个理论存在性别差异。从不饮酒的女性患冠心病的风险反而比规律适度饮酒的人高，但从不饮酒的男性没有这个现象。”
总体来看，6个队列研究所包括的35,132人中，有1,718人（4.9%）在研究期间罹患冠心病，其中有325人（0.9%）病情严重。冠心病发病率在曾经饮酒但已戒酒的人群中最高，达到6.1%，其中1.2%为严重病例；在规律重度饮酒者中最低，为3.8%，其中0.6%为严重病例。作者提醒，由于参与研究的重度饮酒者较少，尤其是女性重度饮酒者，因此重度饮酒者的冠心病发病率存在很大的疑问。
O’Neill博士说：“在人群级别的研究中，重度饮酒者的样本数量往往都不足，因此虽然我们的研究显示重度饮酒者的冠心病发病率并不算高，但这一结果的解读必须非常谨慎，毕竟我们已经知道重度的酒精摄入会引起很多健康问题。”
这个研究的结果表明，长期且不稳定的饮酒行为可能带来冠心病风险。作者认为，这或许是因为不稳定的饮酒行为反映出的往往是生活方式上更多方面的不稳定，包括健康状况不佳或生活压力。
生活方式上的变化可能还与研究者观察到的不同年龄组之间的风险差异有关。
O’Neill博士说：“把样本人群按年龄分组后，我们发现不规律适度饮酒者冠心病风险升高的现象，只存在于55岁以上人群，更为年轻的组别中没有这一现象。究其原因，可能是年龄较长的人群会经历像退休这样的生活方式的变化，而这一类变化往往伴随着饮酒量的增加，这些因素都可能会造成不同年龄间的风险差异。”
为了研究冠心病和长期饮酒行为之间的关系，研究者对6个研究中关于自我手机版每周饮酒量的前瞻性纵向数据进行了分析，这6个研究中有5个来自英国，1个来自法国，数据中包括十年间的饮酒量和冠心病的相关信息。
长期饮酒行为按自我手机版的酒精类型评估摄入量；半品脱（约合240毫升）啤酒或苹果酒、小杯的红酒和一杯烈酒在英国研究中换算为8克酒精，法国研究中则换算为10克酒精。适度饮酒的标准是，男性每周不超过168克酒精，女性每周不超过112克酒精。
作者提醒，由于缺少在十年研究之前的酒精摄入信息，此研究中的非饮酒者也可能包括一些曾经饮酒但已经戒酒的人。患病的重度饮酒者可能也不会被包含在研究样本中，因为他们很可能在研究早期就退出了项目。另外本研究中包含的6个研究都是观察性研究，因此无法得出因果性结论。
摘要：
Background
Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD.
Methods
Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants’ intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories association with CHD onset, adjusting for demographic and clinical characteristics.
Results
Compared to consistently moderate drinkers (males: 1–168 g ethanol/week; females: 1–112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02–1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13–1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21–1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors.
Conclusions
Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake.
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