Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1992 Nov;68(5):443–448. doi: 10.1136/hrt.68.11.443

Alcohol and sudden cardiac death

Goya Wannamethee 1, A G Shaper 1
PMCID: PMC1025184  PMID: 1467026

Abstract

Objective—To assess the relation between alcohol intake and sudden cardiac death—ie, death within one hour of the onset of symptoms.

Design—Prospective study of a cohort of men followed up for eight years.

Setting—General practices in 24 towns in England, Wales, and Scotland.

Subjects—7735 men aged 40–59 at screening who were selected at randon from one general practice in each of 24 towns.

Main outcome measure—All deaths from ischaemic heart disease with particular reference to those that were sudden (death within one hour of the onset of symptoms).

Results—During the follow up period of eight years there were 217 deaths from ischaemic heart disease of which 117 (54%) were classified as sudden. Although heavy drinkers (more than six drinks daily) did not show a high incidence rate of fatal heart attack, they showed the highest incidence rate of sudden cardiac death. This was seen in both manual and non-manual workers and was most clearly seen in older (50–59) men. Death from ischaemic heart disease was more likely to be sudden in heavy drinkers than in other drinking groups; this phenomenon was seen irrespective of the presence or degree of pre-existing ischaemic heart disease. The positive association between heavy drinking and the incidence of sudden death was most apparent in men without pre-existing ischaemic heart disease, with heavy drinkers showing an increase of >60% compared with occasional or light drinkers. After adjustment for age, social class, and smoking, heavy drinkers free of pre-existing ischaemic heart disease had a marginally significantly higher incidence rates of sudden death than other drinkers combined (relative risk 2·00, 95% confidence interval 0·98 to 4·8). Additional adjustment for systolic blood pressure reduced the risk to 1·7.

Conclusions—This study suggests that heavy drinking is associated with an increased risk of sudden death. Studies that do not take pre-existing ischaemic heart disease into account are likely to underestimate the adverse effects of heavy drinking on the incidence of sudden death because the effects are not as evident in men with pre-existing ischaemic heart disease.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boffetta P., Garfinkel L. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology. 1990 Sep;1(5):342–348. doi: 10.1097/00001648-199009000-00003. [DOI] [PubMed] [Google Scholar]
  2. Chiang B. N., Perlman L. V., Fulton M., Ostrander L. D., Jr, Epstein F. H. Predisposing factors in sudden cardiac death in Tecumseh, Michigan. A prospective study. Circulation. 1970 Jan;41(1):31–37. doi: 10.1161/01.cir.41.1.31. [DOI] [PubMed] [Google Scholar]
  3. Cook D. G., Shaper A. G., MacFarlane P. W. Using the WHO (Rose) angina questionnaire in cardiovascular epidemiology. Int J Epidemiol. 1989 Sep;18(3):607–613. doi: 10.1093/ije/18.3.607. [DOI] [PubMed] [Google Scholar]
  4. Doyle J. T., Kannel W. B., McNamara P. M., Quickenton P., Gordon T. Factors related to suddenness of death from coronary disease: combined Albany-Framingham studies. Am J Cardiol. 1976 Jun;37(7):1073–1078. doi: 10.1016/0002-9149(76)90427-6. [DOI] [PubMed] [Google Scholar]
  5. Dyer A. R., Stamler J., Paul O., Berkson D. M., Lepper M. H., McKean H., Shekelle R. B., Lindberg H. A., Garside D. Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies. Circulation. 1977 Dec;56(6):1067–1074. doi: 10.1161/01.cir.56.6.1067. [DOI] [PubMed] [Google Scholar]
  6. Ettinger P. O., Wu C. F., De La Cruz C., Jr, Weisse A. B., Ahmed S. S., Regan T. J. Arrhythmias and the "Holiday Heart": alcohol-associated cardiac rhythm disorders. Am Heart J. 1978 May;95(5):555–562. doi: 10.1016/0002-8703(78)90296-x. [DOI] [PubMed] [Google Scholar]
  7. Fraser G. E., Upsdell M. Alcohol and other discriminants between cases of sudden death and myocardial infarction. Am J Epidemiol. 1981 Oct;114(4):462–476. doi: 10.1093/oxfordjournals.aje.a113212. [DOI] [PubMed] [Google Scholar]
  8. Gordon T., Kannel W. B. Drinking habits and cardiovascular disease: the Framingham Study. Am Heart J. 1983 Apr;105(4):667–673. doi: 10.1016/0002-8703(83)90492-1. [DOI] [PubMed] [Google Scholar]
  9. Greenspon A. J., Schaal S. F. The "holiday heart": electrophysiologic studies of alcohol effects in alcoholics. Ann Intern Med. 1983 Feb;98(2):135–139. doi: 10.7326/0003-4819-98-2-135. [DOI] [PubMed] [Google Scholar]
  10. Hinkle L. E., Jr Short-term risk factors for sudden death. Ann N Y Acad Sci. 1982;382:22–38. doi: 10.1111/j.1749-6632.1982.tb55204.x. [DOI] [PubMed] [Google Scholar]
  11. Hinkle L. E., Jr, Thaler H. T., Merke D. P., Renier-Berg D., Morton N. E. The risk factors for arrhythmic death in a sample of men followed for 20 years. Am J Epidemiol. 1988 Mar;127(3):500–515. doi: 10.1093/oxfordjournals.aje.a114826. [DOI] [PubMed] [Google Scholar]
  12. Kannel W. B., Thomas H. E., Jr Sudden coronary death: the Framingham Study. Ann N Y Acad Sci. 1982;382:3–21. doi: 10.1111/j.1749-6632.1982.tb55203.x. [DOI] [PubMed] [Google Scholar]
  13. Kittner S. J., Garcia-Palmieri M. R., Costas R., Jr, Cruz-Vidal M., Abbott R. D., Havlik R. J. Alcohol and coronary heart disease in Puerto Rico. Am J Epidemiol. 1983 May;117(5):538–550. doi: 10.1093/oxfordjournals.aje.a113576. [DOI] [PubMed] [Google Scholar]
  14. Kozarevic D., Demirovic J., Gordon T., Kaelber C. T., McGee D., Zukel W. J. Drinking habits and coronary heart disease: the Yugoslavia cardiovascular disease study. Am J Epidemiol. 1982 Nov;116(5):748–758. doi: 10.1093/oxfordjournals.aje.a113464. [DOI] [PubMed] [Google Scholar]
  15. Lithell H., Aberg H., Selinus I., Hedstrand H. Alcohol intemperance and sudden death. Br Med J (Clin Res Ed) 1987 Jun 6;294(6585):1456–1458. doi: 10.1136/bmj.294.6585.1456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. New units for old. Br Heart J. 1975 Jan;37(1):1–1. [PMC free article] [PubMed] [Google Scholar]
  17. Rosengren A., Wilhelmsen L., Pennert K., Berglund G., Elmfeldt D. Alcoholic intemperance, coronary heart disease and mortality in middle-aged Swedish men. Acta Med Scand. 1987;222(3):201–213. doi: 10.1111/j.0954-6820.1987.tb10661.x. [DOI] [PubMed] [Google Scholar]
  18. Schatzkin A., Cupples L. A., Heeren T., Morelock S., Kannel W. B. Sudden death in the Framingham Heart Study. Differences in incidence and risk factors by sex and coronary disease status. Am J Epidemiol. 1984 Dec;120(6):888–899. doi: 10.1093/oxfordjournals.aje.a113960. [DOI] [PubMed] [Google Scholar]
  19. Shaper A. G. Alcohol and mortality: a review of prospective studies. Br J Addict. 1990 Jul;85(7):837–861. doi: 10.1111/j.1360-0443.1990.tb03710.x. [DOI] [PubMed] [Google Scholar]
  20. Shaper A. G., Pocock S. J., Ashby D., Walker M., Whitehead T. P. Biochemical and haematological response to alcohol intake. Ann Clin Biochem. 1985 Jan;22(Pt 1):50–61. doi: 10.1177/000456328502200104. [DOI] [PubMed] [Google Scholar]
  21. Shaper A. G., Pocock S. J., Walker M., Cohen N. M., Wale C. J., Thomson A. G. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 1981 Jul 18;283(6285):179–186. doi: 10.1136/bmj.283.6285.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Shaper A. G., Pocock S. J., Walker M., Phillips A. N., Whitehead T. P., Macfarlane P. W. Risk factors for ischaemic heart disease: the prospective phase of the British Regional Heart Study. J Epidemiol Community Health. 1985 Sep;39(3):197–209. doi: 10.1136/jech.39.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Shaper A. G., Wannamethee G., Walker M. Alcohol and mortality in British men: explaining the U-shaped curve. Lancet. 1988 Dec 3;2(8623):1267–1273. doi: 10.1016/s0140-6736(88)92890-5. [DOI] [PubMed] [Google Scholar]
  24. Shaper A. G., Wannamethee G., Whincup P. Alcohol and blood pressure in middle-aged British men. J Hum Hypertens. 1988 Aug;2(2):71–78. [PubMed] [Google Scholar]
  25. Singer K., Lundberg W. B. Ventricular arrhythmias associated with the ingestion of alcohol. Ann Intern Med. 1972 Aug;77(2):247–248. doi: 10.7326/0003-4819-77-2-247. [DOI] [PubMed] [Google Scholar]
  26. Suhonen O., Aromaa A., Reunanen A., Knekt P. Alcohol consumption and sudden coronary death in middle-aged Finnish men. Acta Med Scand. 1987;221(4):335–341. doi: 10.1111/j.0954-6820.1987.tb03353.x. [DOI] [PubMed] [Google Scholar]
  27. Suhonen O., Reunanen A., Knekt P., Aromaa A. Risk factors for sudden and non-sudden coronary death. Acta Med Scand. 1988;223(1):19–25. doi: 10.1111/j.0954-6820.1988.tb15760.x. [DOI] [PubMed] [Google Scholar]
  28. Walker M., Shaper A. G. Follow-up of subjects in prospective studies based in general practice. J R Coll Gen Pract. 1984 Jul;34(264):365–370. [PMC free article] [PubMed] [Google Scholar]
  29. Wannamethee G., Shaper A. G. Changes in drinking habits in middle-aged British men. J R Coll Gen Pract. 1988 Oct;38(315):440–442. [PMC free article] [PubMed] [Google Scholar]
  30. Wilhelmsen L., Wedel H., Tibblin G. Multivariate analysis of risk factors for coronary heart disease. Circulation. 1973 Nov;48(5):950–958. doi: 10.1161/01.cir.48.5.950. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES