Preventive cardiology
Joint Associations of Alcohol Consumption and Physical Activity With All-Cause and Cardiovascular Mortality

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Individual associations of alcohol consumption and physical activity with cardiovascular disease are relatively established, but the joint associations are not clear. Therefore, the aim of this study was to examine prospectively the joint associations between alcohol consumption and physical activity with cardiovascular mortality (CVM) and all-cause mortality. Four population-based studies in the United Kingdom were included, the 1997 and 1998 Health Surveys for England and the 1998 and 2003 Scottish Health Surveys. In men and women, respectively, low physical activity was defined as 0.1 to 5 and 0.1 to 4 MET-hours/week and high physical activity as ≥5 and ≥4 MET-hours/week. Moderate or moderately high alcohol intake was defined as >0 to 35 and >0 to 21 units/week and high levels of alcohol intake as >35 and >21 units/week. In total, there were 17,410 adults without prevalent cardiovascular diseases and complete data on alcohol and physical activity (43% men, median age 55 years). During a median follow-up period of 9.7 years, 2,204 adults (12.7%) died, 638 (3.7%) with CVM. Cox proportional-hazards models were adjusted for potential confounders such as marital status, social class, education, ethnicity, and longstanding illness. In the joint associations analysis, low activity combined with high levels of alcohol (CVM: hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.28 to 2.96, p = 0.002; all-cause mortality: HR 1.64, 95% CI 1.32 to 2.03, p <0.001) and low activity combined with no alcohol (CVM: HR 1.93, 95% CI 1.35 to 2.76, p <0.001; all-cause mortality: HR 1.50, 95% CI 1.24 to 1.81, p <0.001) were linked to the highest risk, compared with moderate drinking and higher levels of physical activity. Within each given alcohol group, low activity was linked to increased CVM risk (e.g., HR 1.48, 95% CI 1.08 to 2.03, p = 0.014, for the moderate drinking group), but in the presence of high physical activity, high alcohol intake was not linked to increased CVM risk (HR 1.32, 95% CI 0.52 to 3.34, p = 0.555). In conclusion, high levels of drinking and low physical activity appear to increase the risk for cardiovascular and all-cause mortality, although these data suggest that physical activity levels are more important.

Section snippets

Methods

We used data from 4 population-based studies (the 1997 and 1998 Health Surveys for England [HSE] and the 1998 and 2003 Scottish Health Surveys [SHS]), which were linked prospectively to cause-specific mortality records.10, 11 Data collection was household based, and methodologies were almost identical across all 4 cohorts. Each baseline survey data collection featured nationally representative samples of adults living in households in England and Scotland.12 Samples were drawn using multistage

Results

In the four surveys, data of 40,220 respondents were collected. After exclusion of those below the age of 40 years (n = 15,666), we had 24,554 adults left. Those with diagnosed diabetes mellitus (n = 1,126) and those who stopped drinking due to health conditions (n = 500) were excluded from analyses. Among the remaining 22,928 adults, 99.7% (n = 22,720) completed the alcohol consumption questionnaire. The sample included 20,005 participants after exclusion of adults with missing values for the

Discussion

Our study is among the few to investigate the joint associations between 2 key health-related behaviors, physical activity and alcohol consumption. Low physical activity combined with high levels of drinking had the highest impact on CVM and all-cause mortality compared with active moderate or moderately high drinking. In the joint association analyses, low physical activity compared with higher activity (similar alcohol groups) had a higher negative impact on CVM than higher levels of drinking

Disclosures

The authors have no conflicts of interest to disclose.

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    The Scottish Health Survey is funded by the Scottish Executive. The Health Survey for England is funded by the Health and Social Care Information Centre (a subsidiary of the English Department of Health). This study is independent research arising partly from a Career Development Fellowship (to Dr. Stamatakis) supported by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.

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