Moderate Drinking After Heart Attack Tied to Lower Mortality

March 27, 2012 — Men who drink 2 glasses of alcohol a day after surviving a heart attack are less likely to die from heart disease or other causes than either nondrinkers or those who drink more, according to a study of nearly 2000 health professionals published online March 28 in the European Heart Journal.

Jennifer K. Pai, ScD, assistant professor of medicine and associate epidemiologist, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues used data from the Health Professionals Follow-up Study to track the survival of 1818 men who suffered a heart attack between 1986 and 2006, following-up some participants for as long as 20 years. During the follow-up, some 468 men died.

Although moderate alcohol consumption (between 10.0 and 29.9 g/day) is associated with a lower risk for heart disease and reduced mortality from all causes in healthy populations, the data on post–myocardial infarction (MI) drinking is limited and somewhat contradictory, the authors write.

In the current study, moderate drinking showed clear benefits post-MI in both multivariable-adjusted and unadjusted hazard ratios (HRs). The multivariable-adjusted HR for death from any cause for moderate drinkers compared with nondrinkers was 0.66 (95% confidence interval [CI], 0.51 - 0.86). For light drinkers, who reported consuming between 0.1 and 9.9 g of alcohol per day, the HR was 0.78 (95% CI, 0.62 - 0.97). For heavy drinkers, who consumed 30 g or more of alcohol daily, the HR for all-cause mortality was 0.87 (95% CI, 0.61 - 1.25; P quadratic = .006). The data were adjusted for age at diagnosis, questionnaire follow-up cycle, smoking, body mass index (BMI), physical activity, diabetes, hypertension, lipid-lowering medications, aspirin use, and heart failure.

When just cardiovascular mortality is considered, the benefit for moderate drinkers is more pronounced, with a multivariable-adjusted HR of 0.58 (95% CI, 0.39 - 0.84) compared with 0.74 for light drinkers (95% CI, 0.54 - 1.02) and 0.98 for heavy drinkers (95% CI, 0.60 - 1.60; P quadratic = .003).

"Our findings clearly demonstrate that long-term moderate alcohol consumption among men who survived a heart attack was associated with reduced risk of total and cardiovascular mortality," Dr. Pai said in a news release. "We also found that among men who consumed moderate amounts of alcohol prior to a heart attack, those who continued to consume alcohol 'in moderation' afterwards also had better long-term prognosis."

In this study, participants responded to a questionnaire about alcohol consumption and diet every 4 years and were asked about lifestyle and medical factors (including smoking and BMI) every 2 years. Previous prospective studies examining post-MI alcohol consumption did not include validated measures of pre- and post-MI drinking with long-term follow-up.

Most participants in this study did not change alcohol consumption levels after MI diagnosis. Multivariable-adjusted HRs for total mortality, considering pre-MI alcohol only, compared with nondrinkers, were 0.91 (95% CI, 0.72 - 1.16) for light drinkers, 0.70 (95% CI, 0.52 - 0.93) for moderate drinkers, and 1.00 (95% CI, 0.70 - 1.42) for heavy drinkers. When considering only post-MI consumption, multivariable HRs for total mortality were 0.90 (95% CI, 0.71 - 1.13) for light drinkers, 0.70 (95% CI, 0.52 - 0.92) for moderate drinkers, and 0.79 (95% CI, 0.53 - 1.17) for heavy drinkers.

For cardiovascular morality, the multivariable-adjusted HR for pre-MI alcohol consumption was 0.74 (95% CI, 0.52 - 1.04) for light drinkers, 0.78 (95% CI, 0.53 - 1.15) for moderate drinkers, and 0.85 (95% CI, 0.50 - 1.44) for heavy drinkers. When considering post-MI consumption only, the multivariable HRs for cardiovascular mortality were 0.73 (95% CI, 0.53 - 1.01) for light drinkers, 0.62 (95% CI, 0.42 - 0.93) for moderate drinkers, and 0.77 (95% CI, 0.44 - 1.35) for heavy drinkers.

The study results hinted at an inverse association between alcohol consumption and mortality among patients who increased alcohol consumption, from less than 10 g/day before a heart attack to 10 to 29.9 g/day post-MI. The small number of cases in the analysis led to a CI that crossed 1.0 in multivariable adjustment, and so was not statistically significant.

The data showed that heavy drinking carried a hazard ratio essentially as high as nondrinking.

"Our results, showing the greatest benefit among moderate drinkers and a suggestion of excess mortality among men who consumed more than two drinks a day after a heart attack, emphasise the importance of alcohol in moderation," Dr. Pai said in the release.

"In addition, other studies have shown that any benefits from light drinking are entirely eliminated after episodes of binge drinking," she noted.

The data does not necessarily extrapolate to women, Dr. Pai said in the release. "However, in all other cases of alcohol and chronic disease, associations are similar except at lower quantities for women. Thus, an association is likely to be observed at 5-14.9g per day, or up to a drink a day for women."

The authors have disclosed no relevant financial relationships.

Eur Heart J. Published online March 28, 2012. Abstract

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