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Published on: March 27, 2018
Alcohol consumption, atherosclerotic progression, and prognosis among patients with coronary artery bypass grafts
Kenneth J Mukamal1, Saket Girotra, Murray A Mittleman
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. kmukamal@bidmc.harvard.edu
Insights
Moderate alcohol consumption showed a trend towards better outcomes and less graft progression in patients after coronary artery bypass surgery, though not statistically significant. Further research is needed to confirm these findings for coronary artery bypass graft patients.
Area of Science:
- Cardiology
- Public Health
- Nutritional Science
Background:
- Moderate alcohol consumption is linked to reduced mortality post-myocardial infarction.
- The impact of alcohol intake on prognosis and graft obstruction in coronary artery bypass graft (CABG) patients remains unclear.
Purpose of the Study:
- To investigate the association between alcohol consumption patterns and clinical outcomes in patients who have undergone coronary artery bypass graft surgery.
- To assess the relationship between alcohol intake and the progression of coronary artery disease and graft obstruction.
Main Methods:
- A cohort of 1351 patients from the Post-CABG trial, who had undergone bypass surgery, were analyzed.
- Patients were categorized by weekly alcohol intake: abstention, light, moderate, and heavier drinking.
- Clinical events and graft progression were assessed via coronary angiography and follow-up over a mean of 4.3 years.
Main Results:
- A trend towards fewer clinical events (death, myocardial infarction, stroke, re-intervention) was observed in moderate drinkers (7-13 drinks/week).
- Moderate alcohol intake also showed a trend towards less angiographic progression of coronary artery disease.
- High-density lipoprotein cholesterol levels partially explained the observed trend toward lower risk in moderate drinkers.
Conclusions:
- This study did not find statistically significant differences in prognosis based on alcohol intake in CABG patients.
- However, inverse trends suggest potential benefits of moderate drinking on morbidity and graft progression, similar to other populations.
- Larger studies are required to definitively establish the role of alcohol consumption in the long-term prognosis of patients with coronary artery bypass grafts.
Background:
Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown.
Methods:
We studied 1351 patients enrolled in the Post-CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low-dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow-up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention (<1 drink), light (1-6 drinks), moderate (7-13 drinks), and heavier (> or =14 drinks).
Results:
During follow-up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events (hazard ratio 0.7, 95% CI 0.4-1.1) and less angiographic progression (odds ratio 0.7, 95% CI 0.5-1.1), although neither of these effects were statistically significant. High-density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers.
Conclusion:
We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.
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