Alcohol use disorder increases the risk of nonfatal and fatal cardiovascular disease: an 11-year follow-up of a Polish population-based cohort. The HAPIEE study

INTRODUCTION Self-reported alcohol intake is an inaccurate measure, especially in heavy drinkers. The simple 4-item CAGE questionnaire assessing alcohol use disorder was found to be positively associated with alcohol consumption and mortality. OBJECTIVES This study aimed to investigate the relationship between alcohol use disorder assessed with the CAGE questionnaire and the incidence of cardiovascular disease (CVD) in a population-based Polish sample. PATIENTS AND METHODS A cohort study with an 11 -year follow-up was conducted. A random sample of 10 728 residents of Krakow aged 45 to 69 years completed baseline examination, including the CAGE questionnaire. Information on new cases of CVD was obtained from further questionnaires and confirmed by clinical diagnosis. Data on mortality and causes of death were obtained from the local registry, the Central Statistical Office, and the participants' families. The effect of the CAGE score on the risk of CVD was assessed using Cox proportional hazard models. RESULTS The analysis included 7112 individuals who completed the CAGE questionnaire and were free of CVD at baseline. No alcohol use disorder was reported in 94% of the participants. There was a positive association between the CAGE score and the risk of CVD. In the fully adjusted model, compared with participants scoring 0, the hazard ratios among those scoring 3 and 4 points were 2.19 (95% CI, 1.43-3.37) and 2.79 (95% CI, 1.65-4.73), respectively. The association was somewhat stronger for fatal CVD. CONCLUSIONS We found a strong, graded association between the CAGE score and the risk of CVD incidence, which was independent of other risk factors for CVD. The CAGE questionnaire might be considered as an additional tool to identify individuals at high risk of CVD.