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october 2026
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Association of self-reported alcohol consumption compared with abstention with major adverse cardiovascular events, cancer, and mortality among United States veterans: a cohort study from the Million Veteran Program

Background

Alcohol consumption is a common behavior among United States veterans, yet its impact on long-term health outcomes remains incompletely understood.

Objectives

We conducted a cohort study to examine the associations between alcohol consumption compared with abstinence and major adverse cardiovascular events (MACE; myocardial infarction, stroke, or cardiovascular death), cancers, and total mortality.

Methods

Self-reported alcohol consumption was collected from 438,442 participants from the prospective Million Veteran Program Study (MVP 2011–2024). The outcomes included total mortality, incident cancer and MACE.

Results

A J-shaped association was observed between alcohol and risk of mortality (both P values for linear trend and curvature < 0.0001) and risk of MACE (P value for curvature < 0.0001; P value for linear trend = 0.24). Compared with never drinkers, the hazard ratio (HR) for mortality was 0.86 (0.84, 0.89) for current drinkers with alcohol 0.1 to 30 g/d and 0.84 (0.80, 0.89) for MACE. The HR for cancer was positively associated with higher daily intake among current drinkers: 1.03 (0.99, 1.17) [0.1–30 g/d], 1.06 (1.00, 1.12) [31–60 g/d], 1.20 (1.12, 1.29) [61–90 g/d], and 1.28 (1.12, 1.47) [≥90 g/d] (P for curvature = 0.06, P for linear trend < 0.0001). Compared with participants who reported never smoking and never drinking, the HR for head and neck cancer was 3.21 (2.17, 4.74) among current smokers with moderate alcohol consumption (females ≤14 g/d and males ≤28 g/d) and 5.69 (3.76, 8.62) among current smokers with heavy drinking (P-interaction = 0.03).

Conclusions

Among United States veterans, alcohol consumption was associated with mortality and MACE in a J-shaped pattern, with lower risk observed at moderate consumption levels compared with abstinence or heavier drinking. However, alcohol consumption demonstrates a linear dose–response relationship with cancers, with increased risks for alcohol-related cancers even at moderate consumption levels. The alcohol and head and neck cancer association were significantly exacerbated by smoking.

Additional Info

  • Authors

    Li Yanping; Nguyen Xuan-Mai T.; Houghton Serena C.; Ho Yuk-Lam; Charest Brian R.; Wang Dong D.; Gagnon David R.; Zhang Yu; Gaziano John Michael; Willett Walter C.; Hu Frank B.; Cho Kelly; Wilson Peter W. F.

  • Issue

    Periodical: The American Journal of Clinical Nutrition - Volume: 124 - Number: 4

  • Published Date

    october 2026

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