Interpretation:

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.