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bulletOne to four drinks per day for 6 days per week reduces risk of major coronary event by 67% in Australia.

How Much Alcohol and How Often?

Paper: Population Based Case-Control Study of Alcohol

Consumption and Risk of a Major Coronary Event

Authors: McElduff P, Dobson A

Ref: BMJ 1997; 314: 1159-1164

Related Links on the World Wide Web | Related Literature Searches

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Summary: The effects of alcohol intake on the cardiovascular system remain controversial, although a consensus is emerging that moderate alcohol consumption confers some protection against myocardial infarction (MI). Most studies have considered total weekly alcohol intakes rather than the pattern of drinking. This case-control study from Australia seeks to quantify the effects of both the frequency and quantity of drinking on the heart.

The authors used data derived from the WHO MONICA project that monitors trends and determinants of cardiovascular disease in defined populations in several countries. In this instance, the population studied were all subjects aged 35-69 years in Newcastle, New South Wales, Australia.

Cases were defined as all subjects in the population suffering an MI or possible MI between 1984 and 1994 whether fatal or nonfatal. Coronary deaths with insufficient evidence for further classification were also included. Cases were identified by follow-up of all suspected coronary events in the population. Hospital records were reviewed (including EKG and cardiac enzyme results), and the patients or relatives were interviewed as to past medical and social history, including questions on alcohol consumption. Details of possible cases who died were also derived from autopsy reports and death certificates; 11,511 cases were identified.

From a pool of participants in the MONICA risk factor prevalence studies over a similar time, 6077 controls were selected. They were based on random, stratified samples from the electoral register. Controls had completed questionnaires that included sections on medical history and alcohol intake.

The results were adjusted for smoking history, age, presence of diabetes or hypertension, and past medical history of coronary heart disease or stroke. Data on alcohol consumption were not available for 6% of 8482 living cases and 47% of 3029 cases who died. These cases were excluded from the results. The results show the relative risks of developing a major coronary event associated with various patterns of drinking. One drink equates to 10 g of alcohol.

The results show a significant reduction in risk of a major coronary event in men who drink 1-4 drinks daily and women who drink 1 or 2 drinks daily less than once a week up to 6 days a week when compared to subjects who do not drink alcohol. The men and women who drank with these intakes five or six times a week had the lowest overall relative risks of 0.31 and 0.33, respectively. Interestingly, the risk of a coronary event then rose quite substantially in these low-to-moderate drinkers if they drank alcohol every day so that it was no longer significantly less than in nondrinkers. Drinkers who consumed larger quantities of alcohol less frequently also had increased risks; for example, a man consuming nine drinks on 1 or 2 days a week had a relative risk of 1.6 despite the total weekly alcohol quantity being relatively low. The general results were not significantly altered when control nondrinkers with a past history of heavy drinking were removed from the analysis.

The study used large numbers of subjects. It is unfortunate but probably unavoidable that data on alcohol intake were unavailable on nearly half the cases that died. Most of the data used was self-reported, and it has been observed in the past that subjects may underreport alcohol consumption. The main conclusion is that the answer to the question "how much, how often?" should be "little and often is best, but not every day" -- at least as far as the heart is concerned.

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Related Literature Searches

Click here for the best searches on: moderate intake of alcohol and heart disease | the deleterious versus protective effects of drinking | the relation between insulin sensitivity and alcohol consumption.

Click here for the best searches in HealthSTAR on: alcohol consumption and its effect on heart disease.

Or conduct your own literature search in the MD Answers area of Physicians' Home Page using the suggested key words:

Search Terms: Alcohol, Heart Disease

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Related Links on the World Wide Web
(Links active as of April 21, 1997)

Alcohol and Heart Disease: Mechanisms of Action
PB: Society for Risk Analysis KW: Alcohol, Heart Disease
Alcohol: Pros and Cons
PB: Georgia Tech KW: Alcohol; risks and benefits
Beneficial Effects of Alcohol: Abstract
PB: BMJ KW: Alcohol, Cardiovascular benefits
Beneficial Effects of Alcohol: Letters to the Editor
PB: New England Journal of Medicine KW: Alcohol, Heart disease
Does Alcohol Contribute to Heart Disease?
PB: Cardiovascular Institute of the South KW: Alcohol, Heart disease
Public in Dark about Alcohol and Heart Disease: Press Release
PB: CEI (Competitive Enterprise Institute) KW: Alcohol, Heart disease, Press release
The Mediterranean Paradox
PB: Loyola University Chicago KW: Heart disease, Diet

More related links to this topic, and many others, can be found in the MD Internet Library

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Article References

To find out more about the research behind this recent medical advancement, look up the following references in the MD Answers area of Physicians' Home Page.

1. Jackson R, Scragg R, Beaglehole R. Alcohol consumption and risk of coronary heart disease. BMJ 1991;303:211-216.

2. Woodward M, Tunstall-Pedoe H. Alcohol consumption, diet, coronary risk factors, and prevalent coronary heart disease in men and women in the Scottish heart health study. J Epidemiol Commun Health 1995;49:354-362.

3. Cullen KJ, Knuiman MW, Ward NJ. Alcohol and mortality in Busselton, Western Australia. Am J Epidemiol 1993;137:242-248.

4. Miller GJ, Beckles GLA, Maude GH, Carson DC. Alcohol consumption: protection against coronary heart disease and risk to health. Int J Epidemiol 1990;19:923-930.

5. Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet 1991;338:464-468.

6. Shaper AG, Wannamethee G, Walker M. Alcohol and coronary heart disease: a perspective from the British regional heart study. Int J Epidemiol 1994;23:482-493.

7. Kaufman DW, Rosenberg L, Helmrich SP, Shapiro S. Alcoholic beverages and myocardial infarction in young men. Am J Epidemiol 1985;121:548-554.

8. Jackson R, Scragg R, Beaglehole R. Does recent alcohol consumption reduce the risk of acute myocardial infarction and coronary death in regular drinkers? Am J Epidemiol 1992;136:819-824.

9. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Pajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA project: registration procedures, event rates and case fatality in 38 populations from 21 countries in 4 continents. Circulation 1994;90:583-612.

10. SAS Institute. SAS/STAT software: the GENMOD procedure, release 6.09. Cary, NC: SAS Institute Inc., 1993. (SAS technical report P-243.)

11. Russell M, Cooper ML, Frone MR, Welte JW. Alcohol drinking patterns and blood pressure. Am J Public Health 1991;81:452-457.

12. Hendriks HFJ, Veenstra J, Velthuis-te Wierik EJM, Schaafsma G, Kluft C. Effects of moderate dose of alcohol with evening meal on fibrinolytic factors. BMJ 1994;398:1003-1006.

13. Suh I, Shaten BJ, Cutler JA, Kuller LH. Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. Ann Intern Med 1992;116:881-887.

14. Romelsjo A, Leifman H, Nystrom S. A comparative study of two methods for the measurement of alcohol consumption in the general population. Int J Epidemiol 1995;24:929-936.

15. Midanik L. The validity of self-reported alcohol consumption and alcohol problems: a literature review. Br J Addict 1982;77:357-382.

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