Trends in the Co-Occurrence of Alcohol Use and Cardiovascular Disease Among U.S. Adults, 1999 to 2023

Alcohol use and cardiovascular disease (CVD) are major public health concerns, but their co-occurrence over time remains unclear.

The objective of the study was to examine trends in the co-occurrence of alcohol use and CVD among U.S. adults.

We analyzed 43,465 U.S. adults from 11 cycles of the National Health and Nutrition Examination Survey (1999-2023). Alcohol use was categorized as no drinking (0 drinks/week), low-to-moderate drinking (≤7 drinks/week for women; ≤14 for men), and heavy drinking (>7 for women; >14 for men). Joinpoint regression estimated trends in co-occurrence of alcohol use and overall and type-specific CVD, stratified by age, sex, race/ethnicity, poverty-income ratio and educational attainment. Trends were quantified using annual percentage change (APC).

Among 43,465 adults, 5,180 had CVD. The prevalence of heavy drinking among those with CVD increased from 17.1% in 1999 to 2000 to 33.4% in 2021 to 2023, whereas the prevalence of nondrinkers and low-to-moderate drinkers among participants with CVD declined. In overall population, the prevalence of co-occurrence of heavy drinking and CVD increased from 1.4% to 3.0% (APC: 3.4%; 95% CI: 2.0%-5.1%). Increases appeared more pronounced in adults aged 40 to 59 years (post-2007), women, non-Hispanic Whites, and those with lower poverty-income ratio or educational attainment. The co-occurrence of heavy drinking with heart failure (APC: 3.8%), angina (1.7%), and stroke (5.2%) increased. In contrast, nondrinking with CVD declined (-1.4%), and low-to-moderate drinking with CVD remained stable.

From 1999 to 2023, the co-occurrence of heavy alcohol use and CVD increased substantially, especially among certain demographic groups.