Mortality and light to moderate alcohol consumption after myocardial infarction

doi:10.1016/S0140-6736(98)06351-X

The Lancet

Volume 352, Issue 9144, 12 December 1998, Pages 1882-1885

https://doi.org/10.1016/S0140-6736(98)06351-X Get rights and content

Summary

Background

Although heavy alcohol consumption increases total mortality, light to moderate consumption decreases cardiovascular and all-cause mortality in apparently healthy people. Since data are sparse on the relation of light to moderate alcohol intake to mortality in patients with previous myocardial infarction, we did a prospective study of mortality in men.

Methods

Of 90 150 men in the Physicians' Health Study enrolment cohort who provided information on alcohol intake and who had no history of cancer, stroke, or liver disease, 5358 had a previous myocardial infarction. We estimated alcohol consumption by food-frequency questionnaire.

Findings

During a mean follow-up of 5 years, 920 men died. After adjustment for several potential confounders, moderate alcohol intake was associated with a significant decrease in total mortality (p=0·016). Compared with men who rarely or never drank alcohol, those who drank one to four drinks per month had a relative risk for total mortality of 0·85 (95% CI 0·69-1·05); for two to four drinks per week, the relative risk was 0·72 (0·58-0·89); for one drink per day 0·79 (0·64-9·96); and for two or more drinks per day 0·84 (0·55-1·26).

Interpretation

Men with previous myocardial infarction who consume small to moderate amounts of alcohol have a lower total mortality.

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.

Section snippets

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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Cited by (157)

Alcohol intake and long-term mortality risk after myocardial infarction in the Alpha Omega Cohort
2022, American Journal of Clinical Nutrition
Population-based studies generally show J-shaped associations between alcohol intake and mortality from cardiovascular disease (CVD). Little is known about alcohol and long-term mortality risk after myocardial infarction (MI).
We examined alcohol intake in relation to all-cause, CVD, and ischemic heart disease (IHD) mortality in Dutch post-MI patients of the Alpha Omega Cohort.
The analysis comprised 4365 patients (60–80 years; 79% male) with an MI ≤ 10 years before study enrolment. We used a 203-item FFQ to assess alcohol (total ethanol) and dietary intakes over the past month. Patients were classified as nondrinkers (0 g/d; n = 956) or very light (>0 to 2 g/d; n = 385), light (M: >2 to 10 g/d; F: >2 to 5 g/d; n = 1125), moderate (M: >10 to 30 g/d; F: >5 to 15 g/d; n = 1207), or heavy drinkers (M: >30 g/d; F: >15 g/d; n = 692). HRs of mortality for alcohol intake were obtained from Cox models, adjusting for age, sex, education, smoking, BMI, physical activity, and dietary factors.
Alcohol was consumed by 83% of males and 61% of females. During ∼12 years of follow-up, 2035 deaths occurred, of which 903 were from CVD and 558 were from IHD. Compared to the (combined) reference group of nondrinkers and very light drinkers, HRs for all-cause mortality were 0.87 (95% CI, 0.78–0.98), 0.85 (95% CI, 0.75–0.96), and 0.91 (95% CI, 0.79–1.04) for light, moderate, and heavy drinkers, respectively. For CVD mortality, corresponding HRs were 0.80 (95% CI, 0.67–0.96), 0.82 (95% CI, 0.69–0.98), and 0.87 (95% CI, 0.70–1.08) for light, moderate, and heavy drinkers, respectively. Findings for IHD mortality were similar. HRs did not materially change when nondrinkers or very light drinkers were taken as the reference, or after exclusion of former drinkers or patients with diabetes or poor/moderate self-rated health.
Light and moderate alcohol intakes were inversely associated with mortality risk in stable post-MI patients. These observational findings should be cautiously interpreted in light of the total evidence on alcohol and health. The Alpha Omega Cohort is registered at clinicaltrials.gov as NCT03192410.
Could the moderate consumption of beer be included within a healthy diet?
2015, Semergen
La cerveza es una bebida que lleva formando parte de nuestra vida habitual desde tiempos inmemoriales. Sin embargo, su consumo depende de los hábitos alimentarios y del estilo de vida de las distintas poblaciones.
En los países europeos situados en la cuenca mediterránea, las bebidas fermentadas como la cerveza ocupan un lugar clave en la dieta mediterránea, declarada en 2010 como Patrimonio Cultural Inmaterial de la Humanidad por la UNESCO.
El posicionamiento en el que colaboran de forma conjunta un grupo de expertos de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) y el Centro de Información Cerveza y Salud (CICS) tiene como objetivos, en relación con el consumo moderado de cerveza: a) actualizar el conocimiento basado en la evidencia científica; b) valorar la posibilidad de incluirlo dentro de una alimentación saludable para adultos sanos; c) informar sobre sus posibles beneficios a los profesionales de la salud y a la población en general.
Un panel de expertos, representado por clínicos e investigadores en el campo de la nutrición, se reunió para revisar la literatura científica relacionada con los efectos del consumo moderado de bebidas fermentadas, en particular de la cerveza, y consensuar resultados, conclusiones y recomendaciones emitidas por distintos autores en el ámbito internacional.
La evidencia científica actual refleja que el consumo moderado de cerveza no modifica los parámetros relacionados con la antropometría, tanto los pliegues cutáneos como el peso se mantienen. Su aporte energético es bajo, aunque el contenido en nutrientes y compuestos bioactivos es muy interesante, ya que se ha demostrado su potencial efecto antioxidante, anticarcinogénico, antiinflamatorio y antiviral, así como su efecto beneficioso sobre la salud cardiovascular, obteniéndose con ingestas moderadas una protección mayor que en población abstemia.
A la vista de los resultados obtenidos tras la consulta bibliográfica realizada por el panel de expertos, se puede concluir que el consumo moderado de cerveza puede considerarse como parte de una alimentación saludable. No obstante, el consumo moderado de cerveza tradicional está contemplado en adultos sanos, nunca en menores de edad, mujeres gestantes o personas mayores con medicación susceptible de interaccionar con la ingesta de alcohol.
Beer is a beverage that has been usually included in our habitual diet from immemorial time. However, beer consumption depends on food habits and lifestyle in different populations.
In Mediterranean countries, fermented beverages like beer, takes up a key space in the Mediterranean diet that has been declared in 2010 as Cultural Immaterial World Heritage by UNESCO.
The positioning where the Spanish Society of Primary Care Medicine and the Beer and Health Information Centre have conjointly worked on has the following beer consumption-related aims: a) to update its knowledge based on the scientific evidence; b) to evaluate the possibility to include it within a healthy diet for healthy adults; c) to inform health professionals and the general population about its possible health benefits.
A panel of experts, represented by clinicians and researchers in the field of nutrition held a meeting with the purpose to review the scientific literature related to the effects of the moderate consumption of fermented beverages, particularly beer, and to reach a consensus on the results, conclusions and recommendations suggested and established by other experts at an international level.
The current scientific evidence reflects that moderate consumption of beer does not affect anthropometry related variables. Although energy supply from beer is very low, its nutrients and bioactive compound contents are interesting, since its potential antioxidant effect together with the fact that anti-carcinogenic, anti-inflammatory and anti-viral effects have been demonstrated, as well as its beneficial effect on cardiovascular health, leading to a greater protection than even in the abstemious population.
In view of the results obtained from the literature consulted by the expert panel, we can conclude that the moderate consumption of beer can be considered within a healthy diet. Nevertheless, the general recommendation is addressed only to healthy adults, never to children, adolescents or pregnant women. In the case of elderly people, any beverage containing alcohol should not be recommended for those who are treated with drugs in order to avoid possible interactions with alcohol consumption.
Wine: Good for all cardiovascular diseases?
2014, Presse Medicale
Les effets bénéfiques du vin sont principalement dus aux polyphénols, avec un rôle majeur du resvératrol.
La consommation modérée de vin diminue la mortalité cardiovasculaire.
Effets très favorables dans la pathologie coronaire et sur le cholestérol.
Effets délétères dans l’hypertension artérielle et la cardiomyopathie dilatée.
Recommandation : 1 à 2 verres (10 à 20 g d’alcool) par jour.
Beneficial effects of wine are mainly due to polyphenol components with a major role for resveratrol.
Moderate wine consumption decreases cardiovascular mortality.
Very favorable effects in coronary artery disease and cholesterol.
Deleterious effects in systemic hypertension and dilated cardiomyopathy.
Recommendation: 1 to 2 drinks (10 to 20 g of alcohol) per day.
Wine consumption and risk of cardiovascular events after myocardial infarction: Results from the GISSI-Prevenzione trial
2013, International Journal of Cardiology
To evaluate the association of wine intake with incident cardiovascular events (CVE) and total mortality after myocardial infarction (MI).
We used prospectively ascertained information among 11,248 Italian patients with recent MI enrolled in the GISSI-Prevenzione Trial. Usual wine consumption has been categorised as never/almost never, up to 0.5 L/day, and > 0.5 L/day. Multiple imputation was used for missing values at baseline and during follow-up. We assessed adjudicated cumulative incidence of major CVE during 3.5 years of follow-up and total mortality at long-term follow-up (7.3 years), respectively. Multivariate Cox proportional hazards models were fitted to estimate hazard ratios (HR) first using data at baseline and then updated using time-varying covariates.
During 37,021 person-years of follow-up, 1168 CVE occurred. Moderate wine intake at baseline was associated with significantly reduced risk of CVE (adjusted HR 0.87; 95% CI 0.76–0.99) as compared with non-drinkers. In time-updated analyses, results were virtually the same, though they were barely statistically not significant (adjusted HR 0.88; 95% CI 0.77–1.00). Wine intake was associated with lower risk of total mortality. In time-updated adjusted analyses, patients with wine consumption up to 0.5 L/day (HR 0.83; 95% CI 0.74–0.92) and > 0.5 L/day (HR 0.77; 95% CI 0.63–0.94) had lower mortality compared with non-drinkers (P for trend = 0.0003).
Among patients with established heart disease, moderate consumption of wine seems to be associated with lower incidence of CVE and total mortality as compared with non drinkers.
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease
2012, Journal of the American College of Cardiology
Citation Excerpt :
Although stress-management programs are not of proven value in reducing the risk of cardiovascular events, they are effective in relieving anxiety and reducing depressive symptoms (461). In patients with SIHD who use alcohol, it might be reasonable for nonpregnant women to have 1 drink (4 ounces of wine, 12 ounces of beer, or 1 ounce of spirits) a day and for men to have 1 or 2 drinks a day, unless alcohol is contraindicated (such as in patients with a history of alcohol abuse or dependence or with liver disease) (703–705). ( Level of Evidence: C)
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: Executive summary
2012, Journal of the American College of Cardiology

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ArticlesMortality and light to moderate alcohol consumption after myocardial infarction

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Study population

Results

Discussion

Lancet

Am J Cardiol

Clin Chim Acta

Lancet

Coronary heart disease mortality and alcohol consumption in Framingham

Am J Epidemiol

Drinking and mortality: the Albany Study

Am J Epidemiol

Alcohol and mortality

Ann Intern Med

Prospective study of moderate alcohol consumption and mortality in US male physicians

Arch Intern Med

Alcohol consumption and mortality among middle-aged and elderly US adults

N Engl J Med

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

Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction

Epidemiol Rev

Articles
Mortality and light to moderate alcohol consumption after myocardial infarction