Abstract
OBJECTIVES: Alcohol consumption above recommended limits has been associated with increased cardiovascular disease (CVD) risk in observational studies. In particular, little is known about the association between high-risk drinking and cardiovascular health (CVH), as assessed by the American Heart Association's Life's Essential 8 (LE8) health metrics, in the context of community-based population datasets. Therefore, this study aimed to determine the relationship between high-risk drinking and CVH status using data from the 2016-2021 Korea National Health and Nutrition Examination Survey (KNHANES). DESIGN: Cross-sectional secondary analysis study. SETTING: The 2016-2021 KNHANES. PARTICIPANTS: This analysis included 18 500 adults aged 19 years or older. PRIMARY AND SECONDARY OUTCOME MEASURES: High-risk drinking was defined as consuming seven or more drinks (or five cans of beer) in one sitting for men, and five or more drinks (or three cans of beer) for women, at least once a month. The frequency of high-risk drinking was categorised as follows: 'rarely or never', 'less than once per month', 'at least once per month', 'once a week' or 'nearly daily'. We calculated an LE8 score for each of eight composite metrics, with each metric ranging from 0 to 100. LE8 total scores were categorised as 0-49, 50-79 and 80-100, representing low, moderate and high CVH, respectively. We used weighted log-linear regression models to analyse the relationship between high-risk drinking and CVH. RESULTS: Nearly daily or weekly high-risk drinking was reported by 37.3% of men and 14.7% of women. The mean CVH score of groups with more frequent high-risk drinking decreased linearly in both sexes. Using the 'nearly daily' drinking group as the reference group, the exponential coefficients (exp(B)) showed that the total CVH score increased progressively as the frequency of high-risk drinking decreased in both men and women. Compared with the 'nearly daily' group, the total CVH score was 5% higher in the 'once a week' group (exp(B)=1.05, p<0.001) and 14% higher in the 'rarely or never' group (exp(B)=1.14, p<0.001) for men. Similar trends were observed for female participants (once a week: exp(B)=1.04, p<0.001; rarely or never: exp(B)=1.13, p<0.001). CONCLUSIONS: This study found that high-risk drinking was negatively associated with ideal CVH in Korean adults, and this association showed sex differences. Interventions targeting high-risk drinking may be more effective than focusing on overall alcohol consumption.