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We measured the association between long\u2010term alcohol consumption and incident health risk conditions related to cardiometabolic risk markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>A prospective cohort analysis was conducted using data from a population\u2010based cohort (2001\u20132020) of 4708 Koreans aged 40\u201369\u2009years who were free of chronic diseases, including metabolic syndrome, at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Alcohol consumption and incident cases related to cardiometabolic risk markers were assessed biennially using interviewer\u2010administered questionnaires or health examinations. The average alcohol intake was calculated to reflect long\u2010term consumption. Alcohol consumption was categorized as none or rarely (0\u20132\u00a0g\/day), light (2\u2009&lt;\u2009\u221216\u2009g\/day, within guideline limits), medium (16\u2009&lt;\u2009\u221232\u2009g\/day) and heavy (&gt;32\u2009g\/day).<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>After full adjustment for covariates, light, medium or heavy alcohol consumption was positively associated with metabolic syndrome [hazard ratio (HR)\u2009=\u20091.55, 95% confidence interval (CI) = 1.32\u20131.83], abdominal obesity (HR\u2009=\u20091.41, 95% CI = 1.17\u20131.70), hyperglycemia (HR\u2009=\u20091.91, 95% CI = 1.62\u20132.26), high blood pressure (HR\u2009=\u20092.04, 95% CI = 1.72\u20132.41) and hypertriglyceridemia (HR\u2009=\u20091.59, 95% CI = 1.30\u20131.93), with the results presented for heavy alcohol consumption only (<jats:italic>p<\/jats:italic>\u2010values for trend &lt;0.001 for all cases). By sex, positive associations between light alcohol intake and hyperglycemia and high blood pressure were observed only in women (<jats:italic>p<\/jats:italic>\u2010values for interaction and <jats:italic>p<\/jats:italic>\u2010values for trend &lt;0.05 for all cases).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Long\u2010term light (within guideline limits), medium or heavy alcohol consumption appears to be positively and linearly associated with incident health risk conditions related to cardiometabolic risk markers. The threshold dose of alcohol for developing hyperglycemia and high blood pressure appears to be lower in women.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.70092","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T23:54:22Z","timestamp":1747871662000},"page":"1840-1852","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long\u2010term alcohol consumption and incident health risk conditions related to cardiometabolic risk markers: A 20\u2010year prospective cohort study"],"prefix":"10.1111","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4245-8437","authenticated-orcid":false,"given":"Sooyeun","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Food and Nutrition Kyung Hee University  Seoul South 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