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To examine the association between alcohol consumption and prognosis in individuals with pre-existing cardiovascular disease (CVD), we conducted a series of meta-analyses of new findings from three large-scale cohorts and existing published studies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We assessed alcohol consumption in relation to all-cause mortality, cardiovascular mortality, and subsequent cardiovascular events via de novo analyses of 14,386 patients with a previous myocardial infarction, angina, or stroke in the UK Biobank Study (median follow-up 8.7 years, interquartile range [IQR] 8.0\u20139.5), involving 1640 deaths and 2950 subsequent events, and 2802 patients and 1257 deaths in 15 waves of the Health Survey for England 1994\u20132008 and three waves of the Scottish Health Survey 1995, 1998, and 2003 (median follow-up 9.5 years, IQR 5.7\u201313.0). This was augmented with findings from 12 published studies identified through a systematic review, providing data on 31,235 patients, 5095 deaths, and 1414 subsequent events. To determine the best-fitting dose-response association between alcohol and each outcome in the combined sample of 48,423 patients, models were constructed using fractional polynomial regression, adjusting at least for age, sex, and smoking status.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Alcohol consumption was associated with all assessed outcomes in a J-shaped manner relative to current non-drinkers, with a risk reduction that peaked at 7 g\/day (relative risk 0.79, 95% confidence interval 0.73\u20130.85) for all-cause mortality, 8 g\/day (0.73, 0.64\u20130.83) for cardiovascular mortality and 6 g\/day (0.50, 0.26\u20130.96) for cardiovascular events, and remained significant up to 62, 50, and 15 g\/day, respectively. No statistically significant elevated risks were found at higher levels of drinking. In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>For secondary prevention of CVD, current drinkers may not need to stop drinking. However, they should be informed that the lowest risk of mortality and having another cardiovascular event is likely to be associated with lower levels of drinking, that is up to approximately 105g (or equivalent to 13 UK units, with one unit equal to half a pint of beer\/lager\/cider, half a glass of wine, or one measure of spirits) a week.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12916-021-02040-2","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T01:02:48Z","timestamp":1627347768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women"],"prefix":"10.1186","volume":"19","author":[{"given":"Chengyi","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara","family":"O\u2019Neill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Stamatakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Britton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"2040_CR1","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.ijcard.2014.11.107","volume":"180","author":"MF Piepoli","year":"2015","unstructured":"Piepoli MF, Corr\u00e0 U, Abreu A, Cupples M, Davos C, Doherty P, et al. 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Ethics approvals for HSE 1994-97 were granted by Local Research Ethics Committees in England, HSE 1998-99 by London North Thames Multicentre Research Ethics Committee (MREC\/97\/2\/9, MREC\/98\/2\/89), HSE 2000-07 by London Multicentre Research Ethics Committee (MREC\/99\/2\/91, MREC\/00\/2\/81, MREC\/01\/2\/82, MREC\/02\/2\/72, MREC\/03\/2\/97, 04\/MRE02\/50, 05\/MREC02\/47, 06\/MRE02\/62), and HSE 2008 by Oxford A-Research Ethics Committee (07\/H0604\/102). SHeSs 1995 and 1998 were approved by all fifteen of the Research Ethics Committees for all Area Health Boards in Scotland, and SHeSs 2003 by Multicentre Research Ethics Committee for Scotland. All participants gave verbal consent to be interviewed for the survey. UK Biobank received approval from the North West Centre for Research Ethics Committee (11\/NW\/0382) and all participants gave written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr Steven Bell is Editorial Board Member for BMC Medicine. The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"167"}}