DLM: Alcohol and Coronary Heart Disease (2007-2010)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To evaluate the relationship between wine and beer consumption and vascular risk and to give a quantitative estimate of the relationship.
Inclusion Criteria:
  • listed in PUBMED
  • published prior to October 2001
  • evaluated relationship of alcohol consumption and vascular risk
  • risks reported specific for beer and wine
Exclusion Criteria:
  • multiple reports on same cohort
  • failure to report confidence intervals or precise probability values

Description of Study Protocol:

Recruitment

selection of studies from the literature applying the above criteria; the original collection of 80 studies was pared down to 30.

Design

Multiple separate meta analyses performed: 23 studies reporting data for wine and 22 studies reporting data for beer and studies that compared nondrinkers and drinkers (of beer or wine) and studies that compared quantities consumed.

Blinding used (if applicable)

NA

Intervention (if applicable) NA

Statistical Analysis

Meta analysis using the general variance-based method.  rr calculated compared to nondrinkers. Publication bias was tested using funnel plot asymetry and no bias was found. 

Data Collection Summary:

Timing of Measurements

Both prospective and case-control studies included.

Dependent Variables

  • Vascular disease,
  • CHD and CVD, both fatal and nonfatal events.

Independent Variables

  • consumption of beer or wine

Control Variables

  • sex in some comparisons
Description of Actual Data Sample:

Initial N: (e.g., 731 (298 males, 433 females)) 80 studies from initial search

Attrition (final N):  26 studies, 23 reporting wine (201,308 persons) and 22 beer (208,096 persons). 

Age: adults

Ethnicity: not stated

Other relevant demographics: some studies included men only

Anthropometrics (e.g., were groups same or different on important measures) NA

Location: investigators live/work in Italy, but studies came from numerous locations.

 

Summary of Results:

Variables

Wine

Beer

 

N of studies

RR

99% confidence intervals

N of studies

RR

99% confidence intervals

Overall

13

0.68 

0.59-0.77

15

0.78

0.70-0.86

Type of cohort

prospective studies

5

0.64 

0.50-0.83

8

0.79

0.67-0.94

case-control studies

8

0.71 

0.56-0.90

 

 

 

Type of event

CHD

11

0.71

0.59-0.85

13

0.79

0.68-0.91

CVD

2

0.43

0.24-0.78

2

0.67

0.41-1.10

Nonfatal vascular event

8

0.71

0.56-0.90

7

0.74

0.57-0.96

Cardiovascular mortality

2

0.49

0.34-0.70

3

0.76

0.55-1.05

Sex effect

Only men

6

0.87

0.68-1.12

6

0.82

0.68-0.99

Both sexes

7

0.53

0.42-0.68

9

0.72

0.58-0.90

Other Findings

There was strong evidence from 10 studies (176,042 persons) to support a J-shaped relationship between different amounts of wine and vascular risk.  A statistically significant inverse association found up to a daily dose of 150 ml. wine. 

There was no sig relationship between different amounts of wine and vascular risk.

Author Conclusion:
Findings show evidence of a sig. inverse association between light to moderate wine consumption and vascular risk. An average sig reduction of 32% of overall vascular risk associated with drinking wine.  Beer drinking was associated with a lower relative risk than not drinking beer but no dose-response pattern could be found and the magnitude of the effect was less than that seen for wine.
Funding Source:
Government: FAIR
University/Hospital: Istituto di Ricerche Farmacologiche Mario Negri, Catholic University (Italy)
Reviewer Comments:

This study was thorough in its attempts to examine factors other than beer or wine consumption that might have affected the outcomes. The general conclusions held when adjusted for social class or to exclude ex-drinkers from the reference group.

The authors describe 150 ml wine as light to moderate wine consumption.  That amount seems less than most people would consider moderate consumption.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? ???
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? ???
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes