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Alcohol intake and mortality in middle aged men with diagnosed coronary heart disease
1Department of Primary Care and Population Sciences, Royal Free and University College Medical Schools, Rowland Hill Street, London NW3 2PF, UK. agshaper@wentworth.u-net.com
Insights
For men with existing coronary heart disease (CHD), light alcohol consumption shows no benefit or harm. However, heavy drinking increases mortality risk, especially after myocardial infarction. Smoking cessation significantly reduces mortality risk.
Area of Science:
- Cardiovascular epidemiology
- Alcohol and public health
Background:
- Established coronary heart disease (CHD) poses significant mortality risks.
- The impact of alcohol consumption on mortality in men with pre-existing CHD requires further investigation.
Purpose of the Study:
- To assess the association between alcohol intake and mortality from coronary heart disease (CHD), cardiovascular disease, and all causes in men with diagnosed CHD.
Main Methods:
- A population-based prospective study followed 7169 men aged 45-64 for a mean of 12.8 years.
- Analysis included 655 men with established CHD, examining mortality outcomes based on alcohol consumption levels (ex-drinkers, lifelong teetotallers, occasional, light, moderate/heavy drinkers).
- Adjustments were made for lifestyle factors and pre-existing conditions.
Main Results:
- Ex-drinkers exhibited the highest risk for CHD, cardiovascular, and all-cause mortality.
- Moderate/heavy drinkers (>/= 3 drinks/day) showed increased mortality, particularly in men with prior myocardial infarction (adjusted relative risk for all-cause mortality 1.50).
- Light alcohol consumption (1-14 units/week) was not associated with significant mortality differences compared to occasional drinkers.
Conclusions:
- Regular light alcohol consumption is not linked to adverse or beneficial effects on mortality in men with established CHD.
- Higher alcohol intake is associated with increased mortality in men with a history of myocardial infarction.
- Smoking cessation significantly reduces all-cause and cardiovascular mortality risk in men with established CHD.
Objective:
To examine the effects of alcohol on risk of mortality from coronary heart disease (CHD), cardiovascular disease, and all causes in men with established CHD.
Methods And Results:
In a population based prospective study of 7169 men aged 45-64 years followed for a mean of 12.8 years, 655 men (9.1%) had a physician diagnosis of CHD (myocardial infarction 455, angina only 200). In these 655 men, there were 294 deaths from all causes including 175 CHD deaths. Ex-drinkers had the highest risk of CHD, cardiovascular mortality, and all cause mortality even after adjustment for lifestyle characteristics and pre-existing disease. Using occasional drinkers as the reference group, lifelong teetotallers, occasional drinkers, and light drinkers all showed similar risks of mortality from CHD, cardiovascular disease, and all causes. Moderate/heavy drinkers showed increased risk of mortality from CHD, cardiovascular disease, and all causes compared to occasional drinkers. The adverse effect of moderate/heavy drinking was confined to the 455 men with previous myocardial infarction (adjusted relative risk for all cause mortality 1.50, 95% confidence interval 1.01 to 2.23). In contrast to lighter drinking, giving up smoking within five years of the start of follow up was associated with a considerable reduction in risk of all cause and cardiovascular mortality compared to those who continued to smoke.
Conclusion:
Compared to occasional drinking, regular light alcohol consumption (1-14 units per week) in men with established coronary heart disease is not associated with any significant benefit or deleterious effect for CHD, cardiovascular disease or all cause mortality. Higher levels of intake (>/= 3 drinks per day) are associated with increased mortality in men with previous myocardial infarction. In contrast, smoking cessation in men with established CHD substantially reduces the risk of mortality.