Relation of Heavy Alcohol Consumption and Angina or Coronary Heart Disease Among U.S. Adults: Analysis of 2016 - 2021 BRFSS Data

Abstract

Background: Heavy alcohol consumption is associated with adverse health outcomes; however, its relationship with coronary heart disease (CHD) and angina remains unclear owing to behavioral, demographic, and clinical factors. Objectives: This study aimed to estimate the survey-weighted association between heavy alcohol consumption and self-reported angina or CHD among U.S. adults. Methods: We analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2016 - 2021 for 2,586,321 adults. The outcome was self-reported angina or CHD (CVDCRHD4). Heavy alcohol consumption was defined using CDC-calculated BRFSS heavy-drinking variables corresponding to > 14 drinks/week for men and > 7 drinks/week for women. Survey-weighted logistic regression accounted for BRFSS weights, strata, and primary sampling units. Adjusted models included age, sex, race/ethnicity, smoking status, physical activity, and overweight/obesity. Results: The weighted prevalence of angina or CHD was 4.11%, and the weighted prevalence of heavy alcohol consumption was 6.33%. Heavy alcohol consumption was associated with lower odds of angina or CHD (adjusted odds ratio [aOR] = 0.66; 95% confidence interval [CI], 0.62 - 0.71). Exploratory subgroup analyses suggested variation among demographic and behavioral groups. Conclusions: In this cross-sectional BRFSS analysis, heavy alcohol consumption was inversely associated with self-reported angina or CHD. These findings should not be interpreted as evidence of a protective effect because reverse causation, survivor bias, residual confounding, and post-diagnosis changes in drinking behavior may explain the observed association. Longitudinal studies are needed to clarify causal relationships.