Cutting Down But Not Out: Very-Heavy Drinkers Needn’t Quit Completely for Cardiovascular Benefit

High-risk drinkers who substantially reduce their alcohol use can lower their risk of cardiovascular disease (CVD) despite not completely abstaining, according to study findings published in Alcoholism: Clinical and Experimental Research. CVD encompasses a range of conditions involving the heart or blood vessels, and is the leading cause of death in the US. It is also one of many negative health outcomes associated with heavy drinking and alcohol use disorder (AUD). Reductions in drinking can be defined using World Health Organization (WHO) ‘risk drinking levels’, which classify drinkers into ‘very high’, ‘high’, ‘moderate’ and ‘low’ risk categories based on their average daily alcohol consumption. Previous research has shown that a reduction of two or more levels (for example, from ‘very high’ to ‘moderate’) can lower the risk of multiple health issues, but did not assess the impact on CVD specifically. The latest study has examined associations between reductions in WHO risk drinking levels and subsequent CVD risk among over one thousand very heavy drinkers in the general US population.

The data were from a national survey (NESARC) in which participants completed a detailed interview at baseline to assess their drinking habits over the previous year. This was used to derive WHO risk drinking levels and identify those of greatest clinical concern, who had a starting risk level of ‘very high’ or ‘high’ (based on an average consumption of at least 4.3 standard drinks per day for men, and 2.9 for women). Participants were also asked if they had experienced a cardiovascular condition (arteriosclerosis, hypertension, angina, tachycardia, or myocardial infarction), as diagnosed by a healthcare professional, within the previous year. Drinking and CVD were also assessed at a 3-year follow up interview.

Using statistical analysis, the researchers showed that a reduction of two or more WHO risk drinking levels between baseline and follow-up was associated with a significantly lower risk of CVD at the 3-year timepoint, compared with drinkers with a less than two-level reduction. Among those starting from a ‘very high’ risk level (who reduced to moderate or low, or who stopped drinking completely), the odds of CVD were lowered by ~40% overall. Among those at ‘high’ baseline risk (who reduced to low or abstinence), there was an ~20% reduction in CVD risk. Including only those who did not reduce to total abstinence made no difference to the findings. However, the results did differ according to age, such that CVD risk was significantly reduced only among very-high risk drinkers aged over 40, and among high-risk drinkers aged 40 or under. Of note, a reduction in risk was observed for both persistence of existing CVD conditions and development of new CVD.

The findings provide further evidence that drinking reductions are associated with important health benefits for very-heavy drinkers in the US general population. This is of relevance to the many people with an AUD who do not want to stop drinking completely, and who can be deterred from seeking treatment when the goal is total abstinence (as is the norm with AUD treatment programs). The research supports a two or more level reduction in WHO risk as a useful goal for treatment providers to discuss with patients, and as a potential outcome for clinical trials of new medications for AUD. Such a goal of drinking reduction without abstinence may help to expand interest in treatment among those most in need.

Reduction in World Health Organization (WHO) risk drinking levels and cardiovascular disease. J. Knox, J. Scodes, K. Witkiewitz, H.R. Kranzler, K. Mann, S.S. O’Malley, M. Wall, R. Anton, D.S. Hasin (pages xxx)

ACER-20-4289.R1

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