THE RISK OF ALCOHOL

We have reviewed 156 papers which provided sufficient information to r elate individual alcohol consumption to risk for a variety of physical damage. Overall, there was evidence for a dose-response relationship between level of alcohol consumption and risk of harm for liver cirrho sis, cancers of the oropharynx, larynx, oesophagus, rectum (beer only) , liver and breast, and blood pressure and stroke. An increased risk o f cardiac arrhythmias, cardiomyopathy and sudden coronary death was as sociated with heavy drinking. There was evidence for a protective effe ct of alcohol consumption against risk of coronary heart disease, whic h could be achieved at consumption levels of less than 10 g alcohol a day. The mortality of non-drinkers was higher than that of moderate dr inkers in some studies. Level of alcohol consumption and total mortali ty were dose-related when non-drinkers were excluded. The finding of a dose-relationship between alcohol and harm suggested causality. It wa s not possible to define individual risk for all harms at a given leve l of alcohol consumption because of variations in methodology, but som e idea of the order of magnitude of the increased risk can be obtained from calculating trends of pooled log-odds ratios. At levels of alcoh ol consumption of more than 20-30 g a day, all individuals are likely to accumulate Fisk of harm. Current guidelines on upper limits of lowe r risk drinking in different countries (168-280 g of alcohol a week fo r men and 84-140 g a week for women) reflect levels at which the risk of total mortality is not greatly increased above one.