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Heavy alcohol consumption but not smoking predicts mortality in patients with acute coronary syndrome
Allan Andersen1, Steven R H Beach2, Willem Philibert1
1Department of Psychiatry, University of Iowa, Iowa City, IA, USA.
Insights
Heavy alcohol consumption (HAC) significantly increases mortality risk in patients with coronary heart disease (CHD). Smoking intensity, however, inversely correlates with coronary artery obstruction severity in these patients.
Area of Science:
- Cardiology
- Epigenetics
- Public Health
Background:
- The impact of heavy alcohol consumption (HAC) and smoking on mortality in coronary heart disease (CHD) patients remains unclear.
- Mechanisms linking these lifestyle factors to adverse outcomes require further elucidation.
Purpose of the Study:
- To investigate the association between epigenetic biomarkers of chronic HAC (Alcohol T-Scores, ATS) and smoking intensity (cg05575921 methylation) with all-cause mortality and coronary artery obstruction.
- To enhance understanding of risk factors in acute coronary syndrome (ACS) patients.
Main Methods:
- Analysis of 217 patients admitted for CHD-related ACS.
- Utilized Alcohol T-Scores (ATS) as a biomarker for chronic HAC.
- Employed cg05575921 methylation as a biomarker for smoking intensity.
- Applied Cox Proportional Hazards models to assess mortality risk and correlation with coronary artery obstruction.
Main Results:
- 65% of subjects exhibited ATS values indicating chronic HAC.
- Higher ATS values were significantly associated with increased all-cause mortality (p < 0.02), with a 2.4-fold increased risk in the highest decile.
- Conversely, cg05575921 methylation was inversely associated with the degree of coronary artery obstruction (p < 0.003), while ATS was not.
- Smoking intensity, not HAC, correlated with less severe coronary obstruction.
Conclusions:
- Heavy alcohol consumption is a significant, underappreciated contributor to mortality in CHD patients.
- Smoking intensity is inversely related to coronary artery obstruction severity in ACS patients.
- Substance use treatment appears underutilized in CHD patient populations.
Abstract:
The relationship of heavy alcohol consumption (HAC) and smoking to mortality in those with CHD, and mechanisms through which these effects are elicited are not clear. In order to improve our understanding, we examined the relationship of Alcohol T-Scores (ATS), an epigenetic biomarker of chronic HAC, and cg05575921 methylation, a biomarker of smoking intensity, with all-cause mortality and degree of coronary artery obstruction in a cohort of 217 subjects admitted for CHD-related acute coronary syndrome (ACS). We found that 65% of the subjects had ATS values indicative of chronic HAC. ATS values, but not cg05575921 values, were significantly associated (p < 0.02) with subsequent proband death (total of 28 deaths) with a Cox Proportional Hazards model showing a slightly larger effect of ATS levels than age on all-cause mortality survival (overall model, p < 0.003). Subjects in the highest decile of ATS scores had a 2.4-fold increase in the risk for mortality as compared to those in the lowest decile. In contrast, cg05575921 methylation (p < 0.003) but not ATS scores, were significantly inversely associated with degree of obstruction. Only 2 of the 217 subjects were referred for treatment for either smoking or drinking. We conclude that HAC is an underappreciated driver of CHD-related mortality, that those with ACS who smoke are much less likely to have significant obstruction upon cardiac imaging and that substance use treatment may be underutilized in those with CHD.
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