Ding, Chengyi; (2022) Alcohol consumption and its association with long-term prognosis among cardiovascular disease patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals, but it remains unclear if this association is also present in those with cardiovascular disease (CVD). Inconsistency exists across guidelines regarding the recommended drinking limits for CVD patients. This thesis consists of three studies aiming to better understand alcohol consumption in this patient population and its association with long-term prognosis. By pooling the results from de novo analyses of three cohorts and 12 published studies identified through a systematic review, meta-analyses of 48423 CVD patients (Study 1) found lower risk of mortality and subsequent cardiovascular events for an alcohol consumption up to 105 grams per week compared to current non-drinking. These effects, however, were significantly attenuated or absent after distinguishing former drinkers from non-drinkers. Meanwhile, little is known about the longitudinal dynamics of alcohol consumption in CVD patients and the associated health risks. With repeated-measures data from two cohorts (n=12502), Study 2 plotted CVD patients’ mean trajectory of weekly alcohol consumption as a function of time, centred on the date of diagnosis and spanning up to 30 years before and after the diagnosis. For male patients, mean consumption increased over time, peaked at eight years before diagnosis at 95 grams per week, and declined afterwards. A flatter trajectory was seen in female patients, which remained stable at around 30 grams per week and started to decline after diagnosis. In Study 3, alcohol consumption trajectory was further differentiated into six distinct groups in an inception cohort of 1306 patients with incident CVD and related to their subsequent mortality risk from all causes. Patients who consistently drank moderately (within 112 grams per week) had a similar risk of mortality as those who were continuous non-drinkers. While increases in risk were found among patients who stopped drinking compared to continuous moderate drinkers, former drinkers also had the worst self-rated health. Temporal variability in alcohol consumption highlights the importance of taking a longitudinal approach to examine alcohol health relations. Findings indicating protective effects of baseline moderate drinking in CVD patients may be largely explained by a referent group contaminated by less healthy former drinkers and are not seen when considering long-term drinking trajectories. This thesis provides novel knowledge about alcohol’s relation to cardiovascular health, which could be used to inform CVD patient care and low-risk drinking guidelines.

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