A healthy lifestyle lowers the risk of cardiovascular diseases and mortality. A new meta-analysis looks at four lifestyle factors, including alcohol consumption, among middle-aged and elderly women specifically. The results indicate that a healthy lifestyle, including moderate alcohol consumption, lowers the risk of cardiovascular diseases and mortality. The study is recently published in the European Journal of Epidemiology.

What is already known? Lifestyle factors are known to affect the risk of cardiovascular diseases (CVD) and mortality in men and women, but physiological effect may differ between sexes and ages. Moderate alcohol consumption is known to decrease the risk of CVD and mortality.

What does this studies add? This meta-analysis looks specifically at the association between four lifestyle factors (alcohol consumption, smoking, physical activity, and obesity) and the risk of CVD and mortality in middle-aged and elderly women. Only observational studies are taken into account and unknown confounding factors cannot be ruled out.

Around the time of menopause cardiovascular disease (CVD) incidence and mortality increases. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition.

Moderate alcohol consumption
This meta-analysis1included 59 studies with over 5 million women to investigate the association between lifestyle factors and the risk of CVD and mortality. For alcohol consumption, 17 studies are included with over 800,000 women. Moderate drinkers, defined as drinking <98 g alcohol/week (about one large drink per day), had a lower risk of coronary heart disease, CVD mortality, and all-cause mortality, compared to abstainers. For higher intakes of alcohol, no associations were found.

The mechanisms underlying the association between alcohol and CVD in women are not fully understood. Changing hormone levels in the specific population group of this study, middle-aged and elderly women, may affect the association between alcohol and cardiovascular diseases. Changes in estrogen-levels during menopause are related to a higher risk of CVD and mortality. Alcohol, on the other hand, may have pro-estrogenic effects. This means that levels of an estrogen-precursor are increased with alcohol intake, which can lead to an increase in HDL cholesterol. These mechanisms support the hypothesis that indirect pathways, such as sex hormones and additional biomarkers, might explain the association between alcohol intake and CVD in women. Further research is required to examine the effect of different beverage types and their specific components.

Healthy lifestyle
The researchers looked at four specific lifestyle factors. Smoking was related with the highest increase in CVD and mortality risk, followed by a high BMI. Physical activity and moderate alcohol consumption were both related to a similar risk reduction. A healthy lifestyle combining these factors – not smoking, physically active, moderate alcohol consumption, and a normal weight – is associated with a lower risk of different cardiovascular outcomes and mortality in older women.


  • Large sample on middle-aged and elderly women specifically.
  • Long follow-up and high quality studies included.


  • Evaluation of changes in lifestyle factors over time is limited.
  • Some studies did not report menopausal status or hormone therapy use.
  • Age taken as proxy for menopause status might affect the results.
  • Included studies differ in methodology.

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