[Alcohol and health--friend or foe?]

The association of alcohol with a number of diseases, accidents, traffic and word injuries, psychoses, degenerative nervous processes and some organ malignities is known and has been proved. An exception is formed by population studies providing evidence of a reduced risk of development of ischaemic heart disease, incl. mortality from the latter. Our population has a high beer consumption: In the West Bohemian region the consumption is 180-200 l of beer per head per year. We were concerned with the problem of the influence of this consumption on the prevalence of IHD, myocardial infarction and some tumours and the general mortality of middle-aged men.

The investigation started in 1976 comprised 3758 men aged 40-50 years. On account of manifest disease 171 subjects were eliminated and in the general evaluation after 12 years another 192 subjects could not be included. The final analysis was made in 3395 men, mean age 44.6 +/- 3.6 years, BMI 27.0 +/- 3.2, mean systolic pressure 133.1 +/- 18 mm Hg (17.74 +/- 2.4 kPa), mean diastolic pressure 83.2 +/- 10.7 mm Hg (11.0 +/- 1.5 kPa) and mean serum cholesterol values 5.69 +/- 0.99 mmol/l. A BMI above 29 was recorded in a total of 835 men (23.6%), systolic pressure above 160 mm Hg (21.23 kPa) in 302 men, diastolic pressure higher than 90 mm Hg (11.98 kPa) in 1004 (28.4%); serum cholesterol above 6.7 mmol/l was recorded in 491 (13.9%) of the examined subjects, regular smoking was admitted by 1915 (54.1%) and regular alcohol intake by 1815 (51.3%) of the investigated subjects. The mean follow-up period was 10.73 years. For statistical analysis multiple logistic regression was used and the relative risk expressed as the "odds ratio" (OR) standardized for a number of variables known to influence in a comprehensive way selected final indicators. Approximately 50% of the men were smokers and consumed alcohol. Regular alcohol intake was associated with a significantly lower risk (odds ratio 0.87). The significant difference was, however, not found when the data were standardized for age, blood pressure, family-history and leisure activities. Separate assessment of the relative risk of alcohol for fatal and non-fatal acute myocardial infarction and for the total mortality rate revealed the following risks (expressed as OR and 95% confidence limit in parentheses: OR for fatal infarction = 0.85 (0.44-1.64), not significant), OR for non-fatal infarction = 0.84 (0.60-1.17) and OR for the general mortality = 0.89 (0.68-1.17): both the latter values are at the borderline of statistical significance (p = 0.05-0.1). When smokers drink regularly, they have a significantly lower risk of non-fatal infarctions (but not fatal infarctions!). This effect is not found in non-smokers. The relative risk for the development of tumours in smokers-drinkers is insignificantly elevated, OR = 1.55 (0.89-2.75). The largest number of malignities was lung cancer. Regular smokers who drink alcohol have a treble risk of developing lung cancer, as compared with abstainers: OR = 2.96 (1.07-8.23) a statistically significant increase.

From the investigation it is apparent that regular alcohol intake reduces the rate of all coronaries in middle-aged men, but this protective effect applies only to non-fatal myocardial infarctions, in particular in smokers. No effect on the general mortality was proved. However, there was evidence of a positive association between alcohol intake and lung cancer. Alcohol potentiates (3x) the relative risk of development of lung cancer in smokers.