Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems
Date
2019
Authors
Sherk, Adam
Gilmore, William
Churchill, Samuel
Lensvelt, Eveline
Stockwell, Tim
Chikritzhs, Tanya
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Environmental Research and Public Health
Abstract
The existence and potential level of cardioprotection from alcohol use is contested in
alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart
disease (IHD) are critical when providing advice for national drinking guidelines and for designing
alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk
to investigate how varying assumptions lead to di erential estimates of alcohol-attributable (AA)
deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and
mortality data were acquired from administrative sources and AA fractions were calculated using the
International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of
Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more
than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective
scenarios resulted in substantial di erences in estimates of net AA deaths in Australia (between 2933
and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related
conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking
guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending
on scenario. Consumption levels resulting in ‘no added’ risk from drinking were found to be between
10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current
guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in
need of downward revision.
Description
Keywords
alcohol harms, national drinking guidelines, alcohol-attributable deaths, alcohol use and ischaemic heart disease, alcohol policy, International Model of Alcohol Harms and Policies, alcohol’s burden of disease, international comparison, Australia, Canada
Citation
Sherk, A., Gilmore, W., Churchill, S. Lensvelt, E., Stockwell, T. & Chikritzhs, T. (2019). Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems. International Journal of Environmental Research and Public Health, 16(24), 4956. https://doi.org/10.3390/ijerph16244956