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Thursday, April 19, 2012

Critique 079: Moderate alcohol consumption both prior to, and following, a myocardial infarction is associated with lower risk of mortality — 17 April

Pai JK, Mukamal KJ, Rimm EB. Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study. European Heart Journal 2012; doi:10.1093/eurheartj

The present paper is based on data from a very well-done prospective follow-up study of male health professionals, initially recruited in 1986. Among the cohort, 1,818 men had a confirmed myocardial infarction (MI) during follow up. The alcohol intake of the subjects had been recorded prior to, and at intervals following, the MI.

There are a number of informative and interesting results described from this study. First, there was little change in reported alcohol prior to and following the MI: drinkers tended to remain drinkers of similar amounts. Few non-drinkers began to drink after their MI; among heavier drinkers, there was a tendency to decrease the amount somewhat (but very few stopped drinking completely). There were no significant differences in outcome according to type of beverage consumed although, interestingly, lower hazard ratios were seen for consumers of beer and liquor than of wine.

The associations of alcohol consumption with mortality were almost the same for alcohol intake reported prior to the MI as that reported after the MI: for 10-29.9 g/day, the adjusted hazard ratio for mortality was 0.70 for both. While the authors state that the effects of alcohol were stronger for the association with non-anterior MIs, the HRs for all-cause mortality were little different: among the moderately drinking men the HRs were 0.58 for anterior MI and 0.51 for other types of MI when compared with abstainers.

The overall results show that, in comparison with no alcohol consumption, the intake of light (0.1-9.9 g/day) and moderate (10.0-29.9 g/d) amounts of alcohol was associated with lower risk of all-cause mortality and cardiovascular morality. The significant reductions in all-cause mortality risk (22% lower for 0.1-9.9 g/day and 34% lower for 10.0 – 29.9 g/day, in comparison with non-drinkers) were no longer present for consumers of ≥ 30 g/day; for this
highest consumer group, the adjusted hazard ratio was 0.87 with 95% CI of 0.61-1.25.

As stated by the authors: “Our findings are consistent with the recent European Society of Cardiology (ESC) recommended guidelines for long-term management of acute coronary syndromes that moderate alcohol consumption of 10–30 g per day in men should not be discouraged and may be beneficial for long-term prognosis after MI.1-3” > > > > Read More