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Alcohol and mortality: the Honolulu Heart Study
Insights
Moderate alcohol consumption may reduce coronary heart disease mortality but increase risks for cancer and stroke deaths in Japanese men. Total mortality risk shows a U-shaped curve, with lowest risk at low intake levels.
Area of Science:
- Epidemiology
- Public Health
- Cardiovascular Research
Background:
- Previous studies indicated lower coronary heart disease (CHD) incidence in Japanese men in Honolulu who consumed alcohol.
- A dose-dependent protective effect of alcohol on CHD was observed, up to approximately 60 ml/day of ethanol.
Purpose of the Study:
- To examine the relationship between alcohol consumption and mortality from specific causes (CHD, cancer, stroke, liver cirrhosis) in Japanese men in Honolulu.
- To determine the overall mortality risk associated with varying levels of alcohol intake in this population.
Main Methods:
- Observational study analyzing mortality data in relation to self-reported alcohol consumption.
- Categorization of participants based on alcohol intake levels, including abstainers and various consumption groups.
- Cause-specific mortality analysis, including coronary heart disease, cancer, stroke, and liver cirrhosis.
Main Results:
- Alcohol consumption showed a reduced risk for coronary heart disease mortality, similar to incidence findings.
- Increased risk of mortality from cancer and stroke was observed with higher alcohol consumption.
- A U-shaped relationship was found for total mortality, with the lowest risk observed in men consuming 1-10 ml/day of ethanol.
- Higher alcohol intake was associated with an increased risk of death from liver cirrhosis.
Conclusions:
- Alcohol consumption in Japanese men in Honolulu presents a complex profile of both benefits (reduced CHD mortality) and hazards (increased cancer, stroke, and liver cirrhosis mortality).
- The net effect of alcohol on mortality is dependent on the specific cause of death being considered.
- Even low levels of alcohol consumption (1-10 ml/day) were associated with increased risks for cancer and stroke mortality compared to abstainers.
Abstract:
It has been shown previously that coronary heart disease was less likely to develop in Japanese men in Honolulu who drank alcoholic beverages than in those who abstained, and that the more they drank (up to about 60 ml/day of ethanol) the lower the risk. In this report on the same men, it is shown that the same sort of relation holds for mortality from coronary heart disease but that the reverse is true for death from cancer and from stroke. Men who drank were more likely to die from these causes than those who abstained, and the more they drank the greater the risk of death. Men who drank relatively large amounts were more likely to die from cirrhosis of the liver than other men. The resultant curve for total mortality is u-shaped, the lowest risk being for men who consumed from 1 to 10 ml/day of ethanol. Even at that low level of consumption, however, the risk of death from cancer or stroke was greater than it was for nondrinkers. In short, for this population of Japanese men, alcohol consumption appears to have some benefits and some hazards with regard to mortality, and the benefit or hazard depends on which cause of death is being considered.