Alcohol consumption and microvascular dysfunction: a J-shaped association: The Maastricht Study

Frank C. T. van der Heide, Simone J. P. M. Eussen, Alfons J. H. M. Houben, Ronald M. A. Henry, Abraham A. Kroon, Carla J. H. van der Kallen, Pieter C. Dagnelie, Martien C. J. M. van Dongen, Tos T. J. M. Berendschot, Jan S. A. G. Schouten, Carroll A. B. Webers, Marleen M. J. van Greevenbroek, Anke Wesselius, Casper G. Schalkwijk, Annemarie Koster, Jacobus F. A. Jansen, Walter H. Backes, Joline W. J. Beulens, Coen D. A. Stehouwer

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Background: Microvascular dysfunction (MVD) is an important contributor to major clinical disease such as stroke, dementia, depression, retinopathy, and chronic kidney disease. Alcohol consumption may be a determinant of MVD. Objective: Main objectives were (1) to study whether alcohol consumption was associated with MVD as assessed in the brain, retina, skin, kidney and in the blood; and (2) to investigate whether associations differed by history of cardiovascular disease or sex. Design: We used cross-sectional data from The Maastricht Study (N = 3,120 participants, 50.9% men, mean age 60 years, and 27.5% with type 2 diabetes [the latter oversampled by design]). We used regression analyses to study the association between total alcohol (per unit and in the categories, i.e. none, light, moderate, high) and MVD, where all measures of MVD were combined into a total MVD composite score (expressed in SD). We adjusted all associations for potential confounders; and tested for interaction by sex, and history of cardiovascular disease. Additionally we tested for interaction with glucose metabolism status. Results: The association between total alcohol consumption and MVD was non-linear, i.e. J-shaped. Moderate versus light total alcohol consumption was significantly associated with less MVD, after full adjustment (beta [95% confidence interval], -0.10 [-0.19; -0.01]). The shape of the curve differed with sex (P interaction = 0.03), history of cardiovascular disease (P interaction < 0.001), and glucose metabolism status (P interaction = 0.02). Conclusions: The present cross-sectional, population-based study found evidence that alcohol consumption may have an effect on MVD. Hence, although increasing alcohol consumption cannot be recommended as a policy, this study suggests that prevention of MVD may be possible through dietary interventions.

Original languageEnglish
Article number67
JournalCardiovascular diabetology
Issue number1
Publication statusPublished - 1 Dec 2023


  • Albuminuria
  • Alcohol
  • Beer
  • Cardiovascular risk factor
  • Cerebral small vessel disease
  • Dyslipidemia
  • Endothelial cell dysfunction
  • Ethanol
  • Flicker light-induced increase in retinal microvascular diameter
  • Heat-induced skin hyperemia
  • History of cardiovascular disease
  • Hypertension
  • Microvascular dysfunction
  • Microvasculature
  • Plasma biomarkers
  • Retinal microvascular diameters
  • Smoking
  • Spirits
  • Type 2 diabetes
  • Wine

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