Role of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease - Role of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease
This study exained the association of patterns of alcohol consumption and the risk of myocardial infarction
Patients Screened: 51,529
Patients Enrolled: 38,077
Mean Follow Up: 12 years
Mean Patient Age: 40-75 years
U.S. male dentists, veterinarians, optometrists, osteopathic physicians, and podiatrists Age 40 to 75 years
History of MI, angina, stroke, transient ischemic attack, claudication, or cancer
Risk of myocardial infarction
Questionnaires regarding diet and medical history were mailed to 38,077 male health professionals from the Health Professionals Follow-up Study in 1986, 1990 and 1994. Average alcohol consumption was assessed with a semiquantitative food-frequency questionnaire, which included separate questions about beer, white wine, red wine, and liquor.
Lower amounts of alcohol consumption were associated with a higher risk of MI during the 12 year follow-up of the study, with a similar risk among light drinkers and those who abstained completely (multivariate relative risk 1.0, 0.98, 0.83, 0.69, 0.79, 0.64, and 0.48 for alcohol consumption of 0 g/day, 0.1-4.9, 5.0-9.9, 10.0-14.9, 15.0-29.9, 30.0-49.9, >=50.0 g/day, respectively, p<0.001 for trend). Likewise, men who consumed alcohol 3-4 or 5-7 days/week had a lower risk of MI compared with men who consumed alcohol <1 day/week (multivariate RR 0.68 and 0.63, respectively, p<0.001 for trend). Increasing alcohol intake by 12.5 g/day during a four-year follow-up period was associated with a lower risk of MI (0.78, 95% CI 0.62 to 0.99) while decreasing daily alcohol consumption by 12.5 g/day during the same time frame was associated with a nonsignificant increase in the risk of MI (RR 1.10, 95% CI 0.92 to 1.31). The association of higher risk of MI with lower amounts of alcohol consumption occurred for all four types of alcohol, although it was strongest for beer and liquor. There was no association between MI risk and timing of the alcohol consumption in its relation to meals. Alcohol consumption was also inversely associated with the risk of undergoing coronary revascularization, with the lowest risk among men who consumed >=50 g/day (multivariate RR 0.59, p <0.001 for trend).
Among men, consumption of alcohol at least 3-4 days per week was associated with a lower risk of MI during the 12 year follow-up. Interestingly, increasing alcohol intake over time was associated with a lower risk of MI while decreasing alcohol consumption was associated with a trend toward a higher risk of MI. It is important to note that the present study showed a benefit of alcohol with moderate but frequent consumption. However, other studies have demonstrated that consuming large quantities of alcohol at a single time are associated with a higher risk of MI, such as the MONICA study where men who had >=9 drinks per day 1-2 days per week had a higher risk of fatal or nonfatal MI vs those who did not drink at all (odds ratio 1.58). In the same study, among men who consumed a moderate amount of alcohol (1-2 drinks on 5-6 days per week), the risk of MI was reduced vs those who did not drink at all (O.R. 0.31). The present study was not a randomized trial but was an epidemiologic study and as such recommendations regarding alcohol consumption cannot be drawn from the results. A prospective, randomized trial would be needed to conclude that alcohol consumption lowers the risk of MI. This study looked specifically at the risk of fatal and non-fatal MI but did not look at all cause mortality, which may be increased by non-coronary factors associated with alcohol consumption such as driving fatalities and liver disease. It is also possible that this is an example of statistical confounding. It may be that people who have a very poor health status such as bad diabetes or renal failure do not drink, and it is possible that co-morbid conditions such as diabetes or renal failure drive the association to coronary artery disease and not the abstinence from alcohol.
N Engl J Med 2003;348:109-118.
Keywords: Odds Ratio, Risk, Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Coronary Disease, Liver Diseases, Renal Insufficiency, Questionnaires, Diet, Health Status, Diabetes Mellitus
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