International Journal of Epidemiology 2000;29:57-64
© International Epidemiological Association 2000
Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women
a Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
b Cardiac Medicine, National Heart & Lung Institute, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, UK.
Reprint requests to: Kiran Nanchahal, Medical Statistics Unit, Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: k.nanchahal{at} lshtm.ac.uk
Background Low to moderate alcohol consumption is associated with reduced mortality, primarily due to a reduction in coronary heart disease (CHD). Conversely, heavy drinking increases mortality, mainly due to haemorrhagic stroke and non-cardiovascular diseases. It is important to identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse. We examine the relationship between reported alcohol consumption, cardiovascular disease (CVD) risk factors, a 10-year CHD risk score and hypertension in women.
Methods In all, 14 077 female employees aged 30–64 years, underwent screening for CVD risk factors. Information was available on a range of personal and lifestyle factors, including height, weight, blood pressure, lipids, lipoproteins, apolipoproteins and blood glucose. Age-adjusted means were computed for the risk factors in each of five groups of reported alcohol intake: <1 (non-drinkers), 1–7, 8–14, 15–21, 
22 units/week. The relationships between alcohol and a derived coronary risk score and hypertension were also examined.
Results Increasing consumption was associated with an age-adjusted increase in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (both P < 0.001), a decline in body mass index, total cholesterol (TC), TC/HDL-C ratio, low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (all P < 0.001), and no trend in triglycerides (P = 0.06), lipoprotein (a) (P = 0.09) or fasting glucose (P = 0.14). Except for LDL-C (P = 0.06) the relationships remained statistically significant after adjustment for possible confounders. Compared to non-drinkers, there was a decrease in 10-year CHD risk with increasing consumption, with the greatest reduction in risk in women consuming 1–7 units/week, odds ratio (OR) = 0.79, (95% CI : 0.72–0.87), and an increase in the prevalence of hypertension among those consuming 15–21 units/week, OR = 1.68, (95% CI : 1.14–2.46).
Conclusions This study provides biological support for an inverse association between alcohol intake and CHD in women, associated with favourable changes in lipid and lipoprotein risk factors. Women consuming 1–14 units/week had a reduction in CHD risk, but there was an increased prevalence of hypertension among those consuming 15 units/week. These data suggest that, in terms of the reduced risk of CVD, women should be advised to restrict their alcohol consumption to 
14 units/week.
Keywords Women, alcohol, risk factors, coronary heart disease, hypertension, safe limits
Accepted 17 August 1999
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