Light-to-moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals; however, it is unclear whether this association is also present in those with disease. To examine the association between alcohol consumption and prognosis in individuals with pre-existing cardiovascular disease (CVD), we conducted a series of meta-analyses of new findings from three large-scale cohorts and existing published studies. We assessed alcohol consumption in relation to all-cause mortality, cardiovascular mortality, and subsequent cardiovascular events via de novo analyses of 14,386 patients with a previous myocardial infarction, angina, or stroke in the UK Biobank Study (median follow-up 8.7 years, interquartile range [IQR] 8.0–9.5), involving 1640 deaths and 2950 subsequent events, and 2802 patients and 1257 deaths in 15 waves of the Health Survey for England 1994–2008 and three waves of the Scottish Health Survey 1995, 1998, and 2003 (median follow-up 9.5 years, IQR 5.7–13.0). This was augmented with findings from 12 published studies identified through a systematic review, providing data on 31,235 patients, 5095 deaths, and 1414 subsequent events. To determine the best-fitting dose-response association between alcohol and each outcome in the combined sample of 48,423 patients, models were constructed using fractional polynomial regression, adjusting at least for age, sex, and smoking status. Alcohol consumption was associated with all assessed outcomes in a J-shaped manner relative to current non-drinkers, with a risk reduction that peaked at 7 g/day (relative risk 0.79, 95% confidence interval 0.73–0.85) for all-cause mortality, 8 g/day (0.73, 0.64–0.83) for cardiovascular mortality and 6 g/day (0.50, 0.26–0.96) for cardiovascular events, and remained significant up to 62, 50, and 15 g/day, respectively. No statistically significant elevated risks were found at higher levels of drinking. In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated. For secondary prevention of CVD, current drinkers may not need to stop drinking. However, they should be informed that the lowest risk of mortality and having another cardiovascular event is likely to be associated with lower levels of drinking, that is up to approximately 105g (or equivalent to 13 UK units, with one unit equal to half a pint of beer/lager/cider, half a glass of wine, or one measure of spirits) a week.

中文翻译：

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饮酒与心血管疾病患者发病率和死亡率的关系：48,423 名男性和女性的原始数据和荟萃分析

据报道，轻度至中度饮酒对明显健康的个体具有心脏保护作用；然而，尚不清楚这种关联是否也存在于疾病患者中。为了检查先前患有心血管疾病 (CVD) 的个体饮酒与预后之间的关系，我们对来自三个大规模队列和现有已发表研究的新发现进行了一系列荟萃分析。我们通过对英国生物库研究中 14,386 名既往心肌梗塞、心绞痛或中风患者的从头分析评估了饮酒与全因死亡率、心血管死亡率和随后心血管事件的关系（中位随访 8.7 年，四分位间距）范围 [IQR] 8.0–9.5)，涉及 1640 例死亡和 2950 例后续事件，在 1994-2008 年英格兰健康调查的 15 轮和 1995、1998 和 2003 年的三轮苏格兰健康调查中，2802 名患者和 1257 人死亡（中位随访时间 9.5 年，IQR 5.7-13.0）。通过系统评价确定了 12 项已发表研究的结果，提供了 31,235 名患者、5095 名死亡和 1414 起后续事件的数据，从而进一步增强了这一点。为了确定 48,423 名患者合并样本中酒精与每个结果之间的最佳拟合剂量反应关联，使用分数多项式回归构建模型，至少调整年龄、性别和吸烟状况。与当前不饮酒者相比，饮酒与所有评估结果呈 J 型相关，风险降低达到峰值 7 g/天（相对风险 0.79，95% 置信区间 0.73-0。全因死亡率为 85），心血管死亡率为 8 g/天（0.73，0.64-0.83），心血管事件为 6 g/天（0.50，0.26-0.96），并且在 62、50 和 15 g 时仍然显着/天，分别。在较高的饮酒水平下，没有发现统计学上显着的风险升高。在将前饮酒者排除在非饮酒参考组之外的少数研究中，轻度至中度饮酒者的风险降低有所减弱。对于 CVD 的二级预防，当前饮酒者可能不需要停止饮酒。然而，他们应该被告知，死亡和发生另一次心血管事件的最低风险可能与较低水平的饮酒有关，即高达约 105 克（或相当于 13 个英国单位，一个单位相当于半品脱）啤酒/拉格/苹果酒，半杯葡萄酒，