GAPA support to WHF Policy Brief
GAPA congratulates the World Heart Federation with the publication of its policy brief: The Impact of Alcohol Consumption on Cardiovascular Health: Myths and Measures. In support of the policy brief GAPA issued the short statement:
Auckland, 15 February 2022
Statement by GAPA in response to the World Heart Federation’s policy brief on the impact of alcohol consumption on cardiovascular health
We wish to express our support for the recommendations made by the World Heart Federation in its policy brief on the use of alcohol products in relation to cardiovascular health.1
Alcohol use is a leading risk factor for death, disability and many other harms.2 The Global Burden of Disease study shows that the risk of death rises with increasing levels of alcohol consumption, and the level of alcohol use that minimises health loss is zero.3 Alcohol also causes multiple cancers, even at low to moderate levels of use.4 There is thus no safe level of alcohol consumption for everyone.
Whether low to moderate alcohol consumption reduces cardiovascular disease in some people remains contentious, as observational studies have limitations such as residual confounding and selection bias.5,6 However, substantial differences between the findings of such studies suggest that even if any “cardioprotective” effects exist, they cannot be assumed for all drinkers.7 More recently, Mendelian randomisation studies using genetic variants to proxy alcohol consumption have not shown cardioprotective associations.8,9 Taken together, the current evidence clearly supports population-level policies to reduce alcohol consumption.
Notably, there is increasing evidence that the alcohol industry misrepresents and funds scientific research on cardiovascular disease to downplay the harms of alcohol use. In a recent study, organisations funded by the alcohol industry were more likely to suggest that alcohol was protective against cardiovascular conditions on their websites, compared to non-industry funded organisations.10 Another study found that systematic reviews conducted by authors funded by the alcohol industry exclusively reported cardioprotective effects of alcohol, and were cited more often than other reviews.11 The alcohol industry also funded a randomised controlled trial to investigate the possible cardioprotective effects of alcohol, which was eventually terminated due to the biased study design.12
To conclude, we call on governments to implement effective public health policies to reduce alcohol use, focusing on the World Health Organization’s SAFER interventions.13 We fully support the World Heart Federation’s appeal to national societies and organisations to play a central role in advocating for stricter alcohol control measures. The voices of civil society organisations independent of commercial interests are essential to counter the alcohol industry’s influence in the prevention and control of alcohol harms.
GAPA is grateful to Dr June Leung, MBBS, MPH, MD ,Massey University, New Zealand and Professor Emerita Jennie Connor, MBChB, MPH, PhD, FNZCPHM, Otago University, New Zealand for preparing this statement.
References
1. World Heart Federation. The impact of alcohol consumption on cardiovascular health: myths and measures. https://world-heart-federation.org/wp-content/uploads/WHF-Policy-Brief-Alcohol.pdf.
2. Shield K, Manthey J, Rylett M, et al. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. The Lancet Public Health. 2020;5(1):e51-e61. doi:https://doi.org/10.1016/S2468-2667(19)30231-2
3. Griswold MG, Fullman N, Hawley C, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018;392(10152):1015-1035. doi:https://doi.org/10.1016/S0140-6736(18)31310-2
4. Rumgay H, Shield K, Charvat H, et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. The Lancet Oncology. 2021;22(8):1071-1080.
5. Naimi TS, Brown DW, Brewer RD, et al. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. American Journal of Preventive Medicine. 2005;28(4):369-373. doi:https://doi.org/10.1016/j.amepre.2005.01.011
6. Naimi TS, Stockwell T, Zhao J, et al. Selection biases in observational studies affect associations between ‘moderate’ alcohol consumption and mortality. Addiction. 2017;112(2):207-214. doi:https://doi.org/10.1111/add.13451
7. Roerecke M, Rehm J. The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis. Addiction. 2012;107(7):1246-1260. doi:https://doi.org/10.1111/j.1360-0443.2012.03780.x
8. Holmes MV, Dale CE, Zuccolo L, et al. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. Bmj. 2014;349:g4164.
9. van de Luitgaarden IA, van Oort S, Bouman EJ, et al. Alcohol consumption in relation to cardiovascular diseases and mortality: a systematic review of Mendelian randomization studies. European journal of epidemiology. 2021:1-15.
10. Peake L, van Schalkwyk MCI, Maani N, Petticrew M. Analysis of the accuracy and completeness of cardiovascular health information on alcohol industry-funded websites. European Journal of Public Health. 2021;31(6):1197-1204. doi:10.1093/eurpub/ckab135
11. Golder S, McCambridge J. Alcohol, cardiovascular disease and industry funding: A co-authorship network analysis of systematic reviews. Social Science & Medicine. 2021;289:114450. doi:https://doi.org/10.1016/j.socscimed.2021.114450
12. Mitchell G, Lesch M, McCambridge J. Alcohol Industry Involvement in the Moderate Alcohol and Cardiovascular Health Trial. American Journal of Public Health. 2020;110(4):485-488. doi:10.2105/AJPH.2019.305508
13. World Health Organization. The SAFER initiative: a world free from alcohol related harm. https://www.who.int/initiatives/SAFER.