Background: Long-term alcohol consumption patterns play a critical role in human health. Objectives: We aimed to identify alcohol consumption trajectories and analyze their associations with coronary heart disease (CHD) and all-cause mortality in the Framingham Heart Study (FHS). Methods: We used a growth mixture model to identify sex-specific alcohol consumption trajectories over 15 years and Cox regression to examine associations of these trajectories with incident events that occurred during an additional 10-year follow-up, adjusting for covariates. Results: We identified four distinct trajectory groups among 6,570 participants (mean age 52; 55% women): Group 1 (n=2,713, reference) consisted of low-level drinkers; Group 2 (n=1,818) mainly included abstainers; Groups 3 (n=805) and 4 (n=1,234) comprised drinkers with varying patterns, with Group 4 consuming the most. Over 10 years of follow-up, women in Groups 2 to 4 had hazard ratios (HR) for CHD of 1.57 (95% CI = 1.11-2.22), 1.57 (95% CI = 1.08-2.29), and 1.27 (95% CI = 1.05-1.55) compared to Group 1. Women in Groups 2 (HR = 1.26, 95% CI = 1.05-1.50) and 3 (HR = 1.27, 95% CI = 1.05-1.55) also had higher all-cause mortality risks. Men in Group 2 had higher mortality (HR = 1.18, 95% CI = 1.02-1.37, P = 0.030) and CHD (HR = 1.56, 95% CI = 1.07-1.52, P = 0.001) risks compared to Group 1, while men in Group 4 had the highest mortality risk (HR = 1.27, 95% CI = 1.02-1.37). Conclusion: This study identified four distinct alcohol consumption trajectories and demonstrated that maintaining low to moderate levels of alcohol drinking over time is likely associated with a lower risk of CHD and mortality in both women and men.

The authors have declared no competing interest.

Data collection for FHS was supported by N01-HC-25195, HHSN268201500001, and grants (R01AG059727, R01AG016495, R01AG008122, RF1AG062109, U19AG068753, R01AA028263) from the National Institute on Aging. R01AA028263 supported YLeng, YLi, JM, and CL. HD was supported by the American Heart Association (20SFRN35360180).

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