Association of Self-Reported Alcohol Consumption Versus Abstention with Major Adverse Cardiovascular Events, Cancer, and Mortality among United States Veterans: a Cohort Study from the Million Veteran Program

BACKGROUND:Alcohol consumption is common behavior among US veterans, yet its impact on long-term health outcomes remains incompletely understood. OBJECTIVE:We conducted a cohort study to examine the associations between alcohol consumption versus abstention and major adverse cardiovascular events (MACE; myocardial infarction, stroke, or cardiovascular death), cancers, and total mortality. METHODS:Self-reported alcohol consumption was collected from 438,442 participants from the prospective Million Veteran Program Study (MVP 2011-2024). The outcomes included total mortality and indent cancer and MACE. RESULTS:A J-shaped association was observed between alcohol and risk of mortality (both Ps for linear trend and curvature<0.0001) and risk of MACE (P for curvature<0.0001; P for linear trend = 0.24). Compared to never drinkers, the hazard ratio (HR) for mortality was 0.86 (0.84, 0.89) for current drinkers with alcohol 0.1-30g/d, and 0.84 (0.80, 0.89) for MACE. The HR for cancer was positively associated with higher daily intake among current drinkers: 1.03 (0.99, 1.17) [0.1-30g/d], 1.06 (1.00, 1.12) [31-60g/d], 1.20 (1.12, 1.29) [61-90g/d] and 1.28 (1.12, 1.47) [>90g/d] (P for curvature =0.06, P for linear trend<0.0001). Compared to participants who reported never smoking and never drinking, the HR for head and neck cancer was 3.21 (2.17, 4.74) among current smokers with moderate alcohol consumption (females up to 14g/d and males up to 28g/d) and 5.69 (3.76, 8.62) among current smokers with heavy drinking (P for interaction=0.03). CONCLUSIONS:Among US Veterans, alcohol consumption was associated with mortality and MACE in a J-shaped pattern, with lower risk observed at moderate consumption levels compared to abstinence or heavier drinking. However, alcohol consumption demonstrates a linear dose-response relationship with cancers, with increased risks for alcohol-related cancers even at moderate consumption levels. The alcohol and head and neck cancer association was significantly exacerbated by smoking.