Abstract Body: Introduction: The association between alcohol consumption and cardiovascular events differs according to the presence or absence of cardiovascular risk factors such as hypertension or dyslipidemia. However, the effect of renal function on that association is unclear in general populations.

Hypothesis: Renal function status modifies the association between alcohol consumption and cardiovascular disease (CVD) risk.

Methods: We followed 10,515 Japanese community dwellers (4,824 men and 5,691 women) without a history of CVD, who participated in the baseline survey of a population-based cohort study conducted between 2012 and 2015, until June 2023. Participants were classified into five groups based on alcohol consumption status: G1 (non-drinkers), G2 (former drinkers), G3 (>0 to <20g/day), G4 (≥20 to <40g/day), and G5 (≥40g/day). Renal dysfunction was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m² or non-negative of semi-quantitative screening tests for urine protein. Hazard ratios (HRs) of alcohol consumption status for CVD, atherosclerotic cardiovascular disease (ASCVD), and intracerebral hemorrhage events were estimated using a Cox proportional hazard model adjusted for confounders. A stratified analysis was performed by renal function status.

Results: During a 9.4-year follow-up, 321 CVD, 206 ASCVD, and 52 intracerebral hemorrhage events were identified. Compared to non-drinkers, alcohol consumption reduced the risk of both CVD and ASCVD. However, in participants with non-negative urine protein, alcohol consumption increased CVD and ASCVD risk, while in those with negative urine protein, it reduced the risk [HR (95% CI) for CVD: G2: 1.00 (0.61-1.66), G3: 0.67 (0.46-0.98), G4: 0.73 (0.48-1.10), G5: 0.66 (0.44-0.99) in negative urine protein; G2: 2.79 (1.04-7.44), G3: 1.19 (0.46-3.08), G4: 3.13 (1.29-7.59), G5: 2.29 (0.95-5.47) in non-negative urine protein]. Reduced eGFR did not affect the association between alcohol consumption and the risk of these events. For intracerebral hemorrhage, alcohol consumption increased risk regardless of renal function.

Conclusions: Alcohol consumption was associated with lower CVD and ASCVD risk in Japanese community dwellers. However, it increased the risk in those with urinary protein and not in those without urinary protein. Reduced eGFR had no effect. These findings suggest that CVD risk from alcohol consumption should be evaluated considering renal dysfunction and the type of pathophysiology.