Sex-Specific Fifteen-Year Alcohol Consumption Trajectories and Their Association with Cardiovascular Events and Mortality: The Framingham Heart Study

Background: Alcohol use patterns influence health outcomes. This study examined sex-specific drinking trajectories and their associations with all-cause mortality and coronary heart disease (CHD) in the US-based Framingham Heart Study. Method: Among 6,570 participants (mean age: 55±13; 55% women) followed for 15 years, a growth mixture model identified four sex-specific alcohol consumption trajectories. Cox models examined associations of alcohol trajectories with CHD and mortality over 10 years of follow-up, adjusting for covariates. Results: The Moderate-Decreasing group (1,179 women, 0–14 g/day; 1,534 men, 0–28 g/day) showed a declining moderate intake. The Low-to-None group included light or non-drinkers (992 women, 826 men). The Inverse-U group (606 women, 199 men) showed variable intake, while the High-Decreasing group (858 women, 376 men) had high (women >14 and men >28 g/day) but declining consumption. Compared with Moderate-Decreasing, women in other groups had higher CHD risks (HRs 1.58-1.61) and greater mortality in Low-to-None (HR 1.25) and Inverse-U (HR 1.28) groups. Men in Low-to-None had higher mortality (HR 1.17) and CHD (HR 1.60), while High-Decreasing showed the highest mortality (HR 1.27). Low-to-moderate drinking was associated with lower mortality and CHD risks; however, these findings do not confirm the protective effects of alcohol use. Discussion: Our findings suggest that sustained low to moderate drinking was associated with lower risks of mortality and CHD in both women and men, compared to high-level or fluctuating patterns. These results emphasize the importance of understanding long-term drinking patterns in public health, but we caution against interpreting moderate use as a means to lower mortality risk or prevent CHD.