The currently recommended safe level of alcohol consumption is associated with increased cardiovascular risk say researchers from Anglia Ruskin University, who suggest that their findings should prompt a reduction in safe alcohol level consumption guidance.

The new research, published in Clinical Nutrition

suggests that even following the current alcohol consumption guidance from the UK’s Chief Medical Officers - which advises:

"To keep health risks from alcohol to a low level, both men and women are advised not to regularly drink more than 14 units a week" - will potentially increase a person’s risk of fatal and non-fatal cardiovascular events, ischaemic heart disease, and cerebrovascular disease.

Risk of Cardiovascular Event Increased in 'Healthy Drinkers'

For their study the researchers analysed data from the UK Biobank study of 333,259 people who drank alcohol, and 21,710 never drinkers, recording those patients who had been hospitalised due to a cardiovascular event.

Participants were aged between 40 to 69 years old and were followed up for a median of 6.9 years. Those who had already suffered a cardiovascular event, those who were former drinkers, and those who had not completed alcohol intake information, were excluded from the analysis.

Those participants who were included in the study were asked about their overall weekly alcohol intake and their intake of specific types of alcohol including beer, wine and spirits. 

The researchers found that for those participants who reported keeping within the current alcohol guidance – drinking less than 14 units a week – the risk of suffering a cardiovascular event was increased by 23% for each additional 1.5 pints of 4% strength beer.

Lead author Dr Rudolph Schutte, course leader for the BSc Hons Medical Science programme and associate professor at Anglia Ruskin University, said: "Among drinkers of beer, cider, and spirits in particular, even those consuming under 14 units a week had an increased risk of ending up in hospital through a cardiovascular event."

He went on to say: "While we hear much about wine drinkers having lower risk of coronary artery disease, our data shows their risk of other cardiovascular events is not reduced."

Bias Masks or Underestimates Alcohol Consumption Hazards Biases

The authors pointed out that the acceptance of the J-shaped curve, which suggests that low to moderate alcohol consumption can be health beneficial, is wrong, and is the result of biases in existing epidemiological data. Dr Schutte said: "Biases embedded in epidemiological evidence mask or underestimate the hazards associated with alcohol consumption."

The authors said that these biases include using non-drinkers as a reference group when many do not drink for reasons of poor health; pooling of all drink types when determining the alcohol intake of a study population, and embedding the lower risk observed of coronary artery disease among wine drinkers. They explained how this potentially distorts the overall cardiovascular risk from drinking alcohol.

"When these biases are accounted for, the adverse effects of even low-level alcohol consumption are revealed," Dr Schutte explained.

Biggest Myth Since 'Smoking is Good for Us'

"The so-called J-shaped curve of the cardiovascular disease-alcohol consumption relationship suggesting health benefit from low to moderate alcohol consumption

is the biggest myth since we were told smoking was good for us," warned Dr Schutte. "Avoiding these biases in future research would mitigate current confusion and hopefully lead to a strengthening of the guidelines, seeing the current alcohol guidance reduced."


Alcohol – The myth of cardiovascular protection
Published:December 13, 2021DOI:


Background & aims

To investigate potential biases that exist in available epidemiological evidence resulting in negative associations or underestimation of cardiovascular (CV) risk associated with alcohol consumption.


UK Biobank involved baseline data collection from 22 assessment centres across the United Kingdom. The cohort consisted of 333 259 alcohol consumers and 21 710 never drinkers. Participants were followed up for a median 6.9 years capturing incident fatal and non-fatal CV events, ischemic heart disease and cerebrovascular disease. Alcohol intake was reported as grams/week.


Using never drinkers as reference, alcohol from all drink types combined (hazard ratios ranging between 0.61 and 0.74),
beer/cider (0.70–0.80) and spirits combined,
and all wines combined (0.66–0.77) associated with a reduced risk for all outcome measures (all CV events, ischaemic heart disease, cerebrovascular disease). In continuous analysis, alcohol captured from all drink types combined (hazard ratio, 1.08, 95% confidence interval, 1.01–1.14), and beer/cider and spirits combined (1.24, 1.17–1.31) associated with an increased risk for overall CV events, however hazard ratios were stronger for beer/cider and spirits (P < 0.0001). Wine associated with a reduced risk for overall CV events (0.92, 0.86–0.98) and ischemic heart disease (0.75, 0.67–0.84).

This negative relationship with overall CV events was lost after excluding ischemic heart disease events (1.00, 0.93–1.08), while the positive association of alcohol captured from beer/cider and spirits remained significant (1.30, 1.22–1.40). This positive association with overall CV events was present even when consuming less than 14 units per week.


Avoiding potential biases prevents underestimation of cardiovascular risk and indicates that consuming up to 14 units per week also associated with increased CV risk in the general population.

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