European long-term study confirms lower mortality rate in life-long moderate drinkers of alcoholic beverages
Individuals who enjoy alcoholic beverages moderately throughout life, live longer. This benefit, largely due to fewer cardiovascular diseases but also other causes, was confirmed by the largest European Prospective Study into Cancer and Nutrition (EPIC) study with approximately 380 000 participants in 8 countries.
The evidence of a J-shaped association between intake of alcoholic beverages and cardiovascular disease (CVD) risk, particularly coronary heart disease (CHD), is well established, with the lowest mortality rate observed in light to moderate drinkers and a higher mortality rate in non-drinkers and very heavy drinkers (1). On the other hand, excessive use of alcoholic beverages has been linked to a greater risk of liver disease, cirrhosis, pancreatitis and various cancers (oral cavity, pharynx, larynx, oesophagus, liver, colorectum and female breast). However, the majority of these findings are based on the alcohol consumption at the time of enrolment into the study, only few data exist from prospective studies where information on lifetime use of alcoholic beverages has been collected.
A recent analysis from the European Prospective Study into Cancer and Nutrition (EPIC), important because of its size and diversity of participants, collected information on the patterns of lifetime alcohol use and the risk of death from leading causes (such as CVD, cancer, diseases of digestive or respiratory system, etc.) from 111 953 men and 268 442 women. A total of 26 411 deaths occurred during an average of 12.6 years of follow up. At ages 20, 30, 40, 50 years and at the time of enrolment, the habitual alcohol use was assessed via questionnaire.
The results showed that “lifetime heavy drinkers” (> 5 drinks/day for men and > 2.5 drinks/day for women) – regardless when they quit or reduced their excessive intake – had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared to subjects in the reference group with “lifetime light use” (> 1 and > 0.5 drink/week for men and women, respectively).
With regards to cardiovascular disease, those who consumed alcoholic beverages moderately, profited the most: compared to lifetime light users, men who consumed less than 5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality. In women, the advantages of consuming alcoholic beverages moderately (less than 2.5 drinks/day) compared to light users in the reference group were also apparent with a 34-46% lower risk of death from coronary heart disease. This relationship, however, was only evident among men and women who had no chronic disease at enrolment (2).
Concerning the all cause mortality in men and women, those who consumed alcoholic beverages in amounts below the recommended limits (the equivalent of 1-2 glasses of wine daily) throughout their lifetime compared to “light lifetime users”, had the lowest relative risk of death. In contrast, excessive drinkers, either at enrolment or in the past, had the highest relative risk of death. Women who never consumed alcoholic beverages also had a greater risk of death than lifetime light users.
Thus, the importance of long-term drinking patterns for health becomes apparent in this study: lifetime moderate drinkers had the best chance to stay healthy for a long time.
Note: The overall net effects of alcohol intake on total mortality (the chance of is dying from any cause) were not included in the publication but were provided in supplementary data online. These graphs show strong J-shaped curves with increasing alcohol intake for both men and women. For men, the risk of up to about 48 gr alcohol/day (the equivalent of approximately four glasses of wine) was lower than that of lifetime light users in the reference group; however, at higher amounts, the risk increased above that of light drinkers. For female drinkers, the risk to die of any cause remained lower than that of the reference group at all reported levels of intake.
Dr. Emily Banks from the Australian National University in Canberra commented the results by stating that the new EPIC analyses „ indicate that it is advisable to avoid heavy drinking throughout life. If taken as causal, these findings are consistent with most public health advice about alcohol, except that most advice recommends an upper limit to alcohol consumption, but does not actually encourage drinking. In fact, the evidence goes further than this and indicates that, in later life, on average and bearing in mind the priorities and risks of specific individuals, drinking at least some alcohol, but not too much, is likely to minimize the overall risk of death.“ (1)
(1) Banks E. Lifetime alcohol consumption and mortality: have some, but not too much. International Journal of Epidemiology 2013;42:1792–17
(2) Bergmann MM, Rehm J, Klipstein-Grobusch K, et al. The association of pattern of lifetime alcohol use and cause of death in the European Prospective Investigation into Cancer and Nutrition (EPIC) studyInternational Journal of Epidemiology 2013;42:1772–1790