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Alcohol consumption and coronary heart disease morbidity and mortality
J T Rehm1, S J Bondy, C T Sempos
1Addiction Research Foundation, Toronto, Ontario, Canada.
Insights
Moderate alcohol intake may protect against coronary heart disease (CHD). However, heavy drinking, especially over 28 drinks weekly for women, increases CHD risk, with no increased risk observed in men at higher intakes.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Alcohol research
Background:
- Alcohol consumption is linked to both reduced coronary heart disease (CHD) risk and increased risks for other health issues.
- The existence and upper limit of a protective effect of alcohol on CHD remain uncertain.
- The relationship between alcohol intake and CHD incidence (ischemic heart disease hospitalization and mortality) requires clarification.
Purpose of the Study:
- To examine the relationship between alcohol consumption and coronary heart disease (CHD) incidence.
- To determine if a U-shaped or L-shaped curve exists for alcohol intake and CHD risk.
- To investigate potential sex differences in the alcohol-CHD relationship.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey I (1971-1975).
- Analyzed follow-up data through 1987 for 6,788 European-American adults aged 40-75.
- Employed Cox regression to assess alcohol consumption's association with CHD incidence and mortality.
Main Results:
- For women, exceeding 28 alcoholic drinks per week was associated with a significantly increased CHD risk (relative risk = 2.6).
- For men, no increased CHD risk was observed even with higher levels of alcohol consumption.
- Mortality data corroborated the findings regarding CHD incidence.
Conclusions:
- A potential threshold for increased CHD risk exists for women consuming over 28 drinks weekly.
- No upturn in risk was identified for men at higher alcohol intake levels.
- Further research into sex differences is crucial for understanding causal mechanisms and informing public health policy.
Abstract:
Alcohol consumption is associated with a reduced risk of coronary heart disease (CHD) but an increased risk of other causes of morbidity and mortality. It remains unclear whether there is an upper limit to a protective effect of alcohol intake on CHD risk. Whether there is a U- or an L-shaped relation between alcohol consumption and CHD incidence (hospitalization and mortality due to ischemic heart disease: International Classification of Diseases codes 410-414) is examined using the National Health and Nutrition Examination Survey I. Baseline data were collected in 1971-1975. Follow-up data through 1987 (14.6 years mean follow-up) were analyzed for 6,788 European-American males (n = 2,960) and females (n = 3,828) aged 40-75 years at baseline. Cox regression was used to assess the association between alcohol consumption and incidence of CHD. For females, an increased risk was found above 28 drinks per week relative to abstainers (relative risk = 2.6, 95% confidence interval 1.2-5.5), which was significant, but was based on small numbers. For males, no upturn in risk was found at higher intake. Mortality data supported these results. Sex differences should be explored further, since they are relevant to understanding causal mechanisms and public policy and prevention.