Author + information
- Min Zhao, MD,
- Sreenivas P. Veeranki, MD, PhD∗ ( )( and )
- Bo Xi, MD
- ↵∗School of Public Health, Shandong University, 44 Wen Hua Xi Road, 250012 Jinan, China
We appreciate the comments from Dr. Braillon on our recent publication (1). We have responded to the comments as listed sequentially in the letter. First, the self-reported responses used to define variables and residual confounding are study limitations and are described in the Discussion. Additionally, we conducted stratified analyses by diagnosis of hypertension and found similar results in both strata. Sensitivity analyses by smoking status revealed that protective effect was more pronounced in never- or ever-smokers. Second, we are aware of the different glass sizes, strengths, alcohol types, and recommended units per week in different countries, and we are working to address these issues in our next studies. Our study was not sponsored by alcohol-related industry, thus, we cannot comment on the use of “moderate alcohol use” as a marketing tool by industry. We intend to use the nomenclature similar to earlier studies that allows for comparison. Third, we agree with the author that drinking 1 to 2 drinks per day is hazardous, which is similar to our study conclusion. Fourth, we agree that our conclusion is not in line with the Mendelian randomization study (2), and we discussed this in our publication. We should keep in mind that the Mendelian randomization study is not the “gold standard” with which to make causal relationship conclusions (3).
We conclude that a J-shaped association exists between alcohol consumption and risk of mortality. Although we used nationally representative samples and robust statistical methods in our study to address previous studies’ limitations, a significant amount of work is needed to address different types of alcohol use, recall bias, and nomenclature that can translated to public health practice. Overall, we re-emphasize that it is too early to conclude that there is a causal protective relationship between light to moderate alcohol drinking and risk of mortality.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- Zhao M.,
- Veeranki S.P.,
- Xi B.
- Holmes M.V.,
- Dale C.E.,
- Zuccolo L.,
- et al.
- Glymour M.M.