Context and Objective: Alcohol intakes may vary considerably over a drinker's lifetime. This study was designed to examine whether lifetime drinking trajectories are associated with cardiovascular risk factors which are used to define the metabolic syndrome.

Design, setting, participants and outcomes: This is a population-based cross-sectional study. Participants were ever regular drinkers (n=2818) selected from healthy controls for the Western New York Health Study (1996–2001) in which lifetime lifestyle was ascertained retrospectively. Prevalence of the metabolic syndrome and its individual components, including obesity, high triglycerides, low HDL cholesterol, elevated blood pressure, high fasting glucose, were the main outcomes.

Results: Trajectory analyses were based on estimates of total kilograms of ethanol for each age decade between 10 to 59 years. Two groups of drinkers with distinct lifetime drinking trajectories were obtained, an early peak and a stable trajectory group. Compared to stable trajectory drinkers, early peak drinkers were 10 years younger on average, had earlier onset of regular drinking, drank heavily in late adolescence and early adulthood tapering off in middle age, averaged more drinks per drinking day in lifetime, and were more likely to abstain when interviewed. After controlling for age, sex and other potential confounders, early peak trajectories were modestly associated with high odds of the metabolic syndrome (1.31, 95% CI:1.00,1.71) overall, low HDL-C (1.62, 95% CI:1.27,2.08), abdominal obesity (1.48, 95% CI:1.23,1.78) and overweight (1.32, 95% CI:1.10,1.60).

Conclusions: Early initiation of alcohol drinking and heavy drinking in adolescence and early adulthood may be associated with an adverse cardiometabolic profile.