ArticlesMortality and light to moderate alcohol consumption after myocardial infarction
Introduction
Many studies have shown a J-shaped relation between the amount of alcohol consumed and total mortality.1, 2, 3, 4 The benefit of light to moderate alcohol intake seems to be mediated largely by a decrease in the risk of coronary mortality.5, 6 This relation is inverse5, 7 or L-shaped8, 9 up to several drinks per day. Conversely, the association of alcohol intake to non-cardiovascular mortality is less consistent; risk possibly decreases with light to moderate intake,6 but increases sharply in heavy drinkers10 because of accidents, liver disease, and certain cancers.11
The potential impact of alcohol intake on total mortality may depend heavily on the rate of coronary mortality relative to other causes of death. In populations with low risk of mortality from coronary disease, the potential benefit of lighter drinking may be less. In populations at high risk of coronary disease, however, such as middle- aged and older men with cardiovascular risk factors, light to moderate alcohol intake may confer greater benefit.6, 12
Patients wth a history of myocardial infarction are at high risk of mortality from reinfarction and sudden death13 and, therefore, are likely to benefit from light to moderate alcohol intake. Several factors might, however, lessen the potential benefit of alcohol consumption. Alcohol drinking is associated with a dose-dependent increase in blood pressure.14, 15 In addition, heavy alcohol intake may decrease left-ventricular ejection fraction due to cardiomyopathy.16, 17 These factors could exert harmful effects with lower alcohol intake in patients with previous myocardial infarction who have a decreased ejection fraction and an increased left-ventricular end-diastolic pressure. Studies of the association of alcohol intake with mortality among patients with cardiovascular disease are limited.18 We examined the relation between alcohol intake and mortality risk in men with a history of myocardial infarction.
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Study population
The Physicians' Health Study is a randomised, double-blind, placebo-controlled trial that is testing two hypotheses of primary prevention: whether 325 mg of aspirin taken on alternate days decreases mortality from cardiovascular disease, and whether 50 mg of β-carotene taken on alternate days decreases the incidence of cancer.19, 20 Potentially eligible participants in the Physicians' Health Study were men living in the USA. In 1982 and 1983 we sent letters of invitation, informed consent
Results
During a mean follow-up period of 5 years, 920 (17·2%) of the 5358 men died. Of those, 710 (77·2%) died from cardiovascular diseases, including 294 from myocardial infarctions, 278 from other ischaemic heart diseases, and 32 from strokes. 95 (10·3%) deaths were caused by cancer and 115 (12·5%) were due to other diseases.
Overall, the alcohol intake was low to moderate, with more than 96% of men reporting consumption of less than two drinks per day. 25% of men drank four or fewer drinks per
Discussion
Our results show that men with a history of myocardial infarction with a light to moderate intake of alcohol have a slight but clinically important decrease in total mortality, compared with those who never or rarely drink alcohol.
The shape of the association curve for alcohol intake and cardiovascular mortality was similar among men with myocardial infarction at baseline to those free of cardiovascular diseases. The curve suggests that the maximum potential benefit of alcohol intake may be
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