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Open AccessArticle

Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems

1
Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
2
National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(24), 4956; https://doi.org/10.3390/ijerph16244956
Received: 30 October 2019 / Revised: 29 November 2019 / Accepted: 1 December 2019 / Published: 6 December 2019
(This article belongs to the Special Issue Alcohol Policy and Public Health)
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 differential 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 differences 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. View Full-Text
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 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
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Sherk, A.; Gilmore, W.; Churchill, S.; Lensvelt, E.; Stockwell, T.; Chikritzhs, T. Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems. Int. J. Environ. Res. Public Health 2019, 16, 4956.

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