Abstract
BACKGROUND AND AIMS: Alcohol use is associated with ischemic heart disease (IHD) mortality. The significant health burden of IHD is not distributed equally across socioeconomic strata and individuals with low socioeconomic status (SES) may be more vulnerable to the health effects of alcohol use. We aim to explore the effect modification of educational attainment on the association between alcohol use and IHD mortality in the United Kingdom (UK). METHODS AND RESULTS: This cohort study utilized UK Biobank data from 387,914 participants (203,081 females and 184,833 males) aged 40-69 years, who reported being current drinkers at baseline. IHD deaths were identified through national death registries. Individuals with low education had a higher risk of IHD mortality compared to those with high education. Among males, alcohol use of >1-30 g/day (without heavy episodic drinking) was associated with 39 % lower risk of IHD mortality compared with occasional alcohol use. In the Cox Proportional Hazard model, a differential association was observed among males with low (interaction term HR: 1.29, 95 % CI 1.01, 1.66) and medium education (interaction term HR: 1.36, 95 % CI:1.03, 1.80), compared to highly educated occasional drinkers. No differential association of alcohol use with IHD mortality by education was observed among females. CONCLUSIONS: These findings suggest that the association between alcohol use and IHD mortality may vary across educational attainment in males. Future research needs to strengthen our understanding of the risk relationship between alcohol use and IHD mortality, while accounting for potential differences by sex and educational attainment.