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

BACKGROUND: Alcohol use and cardiovascular disease (CVD) are major public health concerns, but their co-occurrence over time remains unclear. OBJECTIVES: The objective of the study was to examine trends in the co-occurrence of alcohol use and CVD among U.S. adults. METHODS: 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). RESULTS: 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. CONCLUSIONS: From 1999 to 2023, the co-occurrence of heavy alcohol use and CVD increased substantially, especially among certain demographic groups.