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
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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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