Alcohol use disorder increases the risk of non-fatal and fatal cardiovascular disease events: an 11-year observation of a Polish population-based cohort. The HAPIEE Study.

INTRODUCTION Self-reported alcohol intake is not an accurate measure, especially in heavy drinkers. The simple 4-item CAGE questionnaire assessing alcohol use disorder was found to be positively related with alcohol consumption and mortality. OBJECTIVES To assess the relationship between alcohol use disorder assessed with CAGE questionnaire and the cardiovascular disease (CVD) incidence 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 45-69 completed baseline examination, including the CAGE questionnaire. Information on new CVD cases was obtained from further questionnaires, confirmed by clinical diagnosis. Information on deaths with causes was obtained from the local registry, Central Statistical Office and participants' families. The effect of CAGE score on CVD risk was assessed using Cox proportional hazard models. RESULTS The analysis included 7,112 persons who had completed the CAGE questionnaire and were free of CVD at baseline. No alcohol use disorder was found in 94% of participants. There was a positive association between CAGE score and the CVD risk. In the fully adjusted model, compared to participants scoring 0, the HRs 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 CAGE score and risk of CVD incidence which was independent from other CVD risk factors. The CAGE questionnaire might be considered as an additional tool to identify persons at high CVD risk.