Abstract
OBJECTIVE—To examine the effects of alcohol on risk of mortality from coronary heart disease (CHD), cardiovascular disease, and all causes in men with established CHD. METHODS AND RESULTS—In a population based prospective study of 7169 men aged 45-64 years followed for a mean of 12.8 years, 655 men (9.1%) had a physician diagnosis of CHD (myocardial infarction 455, angina only 200). In these 655 men, there were 294 deaths from all causes including 175 CHD deaths. Ex-drinkers had the highest risk of CHD, cardiovascular mortality, and all cause mortality even after adjustment for lifestyle characteristics and pre-existing disease. Using occasional drinkers as the reference group, lifelong teetotallers, occasional drinkers, and light drinkers all showed similar risks of mortality from CHD, cardiovascular disease, and all causes. Moderate/heavy drinkers showed increased risk of mortality from CHD, cardiovascular disease, and all causes compared to occasional drinkers. The adverse effect of moderate/heavy drinking was confined to the 455 men with previous myocardial infarction (adjusted relative risk for all cause mortality 1.50, 95% confidence interval 1.01 to 2.23). In contrast to lighter drinking, giving up smoking within five years of the start of follow up was associated with a considerable reduction in risk of all cause and cardiovascular mortality compared to those who continued to smoke. CONCLUSION—Compared to occasional drinking, regular light alcohol consumption (1-14 units per week) in men with established coronary heart disease is not associated with any significant benefit or deleterious effect for CHD, cardiovascular disease or all cause mortality. Higher levels of intake (⩾ 3 drinks per day) are associated with increased mortality in men with previous myocardial infarction. In contrast, smoking cessation in men with established CHD substantially reduces the risk of mortality. Keywords: coronary heart disease; alcohol consumption; mortality risk; smoking cessation
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- Ahlawat S. K., Siwach S. B. Alcohol and coronary artery disease. Int J Cardiol. 1994 Apr;44(2):157–162. doi: 10.1016/0167-5273(94)90020-5. [DOI] [PubMed] [Google Scholar]
- Beaglehole R., Jackson R. Alcohol, cardiovascular diseases and all causes of death: a review of the epidemiological evidence. Drug Alcohol Rev. 1992;11(3):275–289. doi: 10.1080/09595239200185811. [DOI] [PubMed] [Google Scholar]
- 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]
- Camargo C. A., Jr, Hennekens C. H., Gaziano J. M., Glynn R. J., Manson J. E., Stampfer M. J. Prospective study of moderate alcohol consumption and mortality in US male physicians. Arch Intern Med. 1997 Jan 13;157(1):79–85. [PubMed] [Google Scholar]
- Doll R., Peto R., Hall E., Wheatley K., Gray R. Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):911–918. doi: 10.1136/bmj.309.6959.911. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Friedman H. S. Acute effects of ethanol on myocardial blood flow in the nonischemic and ischemic heart. Am J Cardiol. 1981 Jan;47(1):61–67. doi: 10.1016/0002-9149(81)90290-3. [DOI] [PubMed] [Google Scholar]
- Goldberg R. J., Burchfiel C. M., Reed D. M., Wergowske G., Chiu D. A prospective study of the health effects of alcohol consumption in middle-aged and elderly men. The Honolulu Heart Program. Circulation. 1994 Feb;89(2):651–659. doi: 10.1161/01.cir.89.2.651. [DOI] [PubMed] [Google Scholar]
- Klatsky A. L., Armstrong M. A., Friedman G. D. Relations of alcoholic beverage use to subsequent coronary artery disease hospitalization. Am J Cardiol. 1986 Oct 1;58(9):710–714. doi: 10.1016/0002-9149(86)90342-5. [DOI] [PubMed] [Google Scholar]
- Klatsky A. L., Armstrong M. A., Friedman G. D. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol. 1990 Nov 15;66(17):1237–1242. doi: 10.1016/0002-9149(90)91107-h. [DOI] [PubMed] [Google Scholar]
- Lampe F. C., Walker M., Lennon L. T., Whincup P. H., Ebrahim S. Validity of a self-reported history of doctor-diagnosed angina. J Clin Epidemiol. 1999 Jan;52(1):73–81. doi: 10.1016/s0895-4356(98)00146-2. [DOI] [PubMed] [Google Scholar]
- Maclure M. Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. Epidemiol Rev. 1993;15(2):328–351. doi: 10.1093/oxfordjournals.epirev.a036124. [DOI] [PubMed] [Google Scholar]
- Muntwyler J., Hennekens C. H., Buring J. E., Gaziano J. M. Mortality and light to moderate alcohol consumption after myocardial infarction. Lancet. 1998 Dec 12;352(9144):1882–1885. doi: 10.1016/S0140-6736(98)06351-X. [DOI] [PubMed] [Google Scholar]
- Preedy V. R., Richardson P. J. Ethanol induced cardiovascular disease. Br Med Bull. 1994 Jan;50(1):152–163. doi: 10.1093/oxfordjournals.bmb.a072873. [DOI] [PubMed] [Google Scholar]
- Rehm J. T., Bondy S. J., Sempos C. T., Vuong C. V. Alcohol consumption and coronary heart disease morbidity and mortality. Am J Epidemiol. 1997 Sep 15;146(6):495–501. doi: 10.1093/oxfordjournals.aje.a009303. [DOI] [PubMed] [Google Scholar]
- Rimm E. B., Klatsky A., Grobbee D., Stampfer M. J. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits. BMJ. 1996 Mar 23;312(7033):731–736. doi: 10.1136/bmj.312.7033.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- 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]
- Shaper A. G., Wannamethee G., Walker M. Alcohol and coronary heart disease: a perspective from the British Regional Heart Study. Int J Epidemiol. 1994 Jun;23(3):482–494. doi: 10.1093/ije/23.3.482. [DOI] [PubMed] [Google Scholar]
- Siwach S. B., Gupta S. P., Lohan A. Acute effects of ethyl alcohol on left ventricular performance in myocardial infarction cases--a study of systolic time intervals. J Assoc Physicians India. 1985 Jun;33(6):389–391. [PubMed] [Google Scholar]
- Suh I., Shaten B. J., Cutler J. A., Kuller L. H. Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. The Multiple Risk Factor Intervention Trial Research Group. Ann Intern Med. 1992 Jun 1;116(11):881–887. doi: 10.7326/0003-4819-116-11-881. [DOI] [PubMed] [Google Scholar]
- Thun M. J., Peto R., Lopez A. D., Monaco J. H., Henley S. J., Heath C. W., Jr, Doll R. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997 Dec 11;337(24):1705–1714. doi: 10.1056/NEJM199712113372401. [DOI] [PubMed] [Google Scholar]
- Walker M. K., Whincup P. H., Shaper A. G., Lennon L. T., Thomson A. G. Validation of patient recall of doctor-diagnosed heart attack and stroke: a postal questionnaire and record review comparison. Am J Epidemiol. 1998 Aug 15;148(4):355–361. doi: 10.1093/oxfordjournals.aje.a009653. [DOI] [PubMed] [Google Scholar]
- 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]
- 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]
- Wannamethee G., Shaper A. G. Men who do not drink: a report from the British Regional Heart Study. Int J Epidemiol. 1988 Jun;17(2):307–316. doi: 10.1093/ije/17.2.307. [DOI] [PubMed] [Google Scholar]