Moderate Alcohol Consumption Post-MI Lowers Risk of Mortality

April 26, 2012

April 25, 2012 (Bethesda, Maryland) — Drinking alcohol, albeit moderately, appears to provide some protective benefit to individuals who survived a first MI, research shows [1]. Drinking up to two drinks per day was associated with a significant reduction in the risk of all-cause and cardiovascular mortality, but the relationship was U-shaped, with data showing no significant benefit and in fact hinting at harm among men who consumed more than the daily recommended serving of alcohol.

"The well-known side effects of excessive alcohol consumption should be considered carefully when providing recommendations to individuals post-MI," caution Dr Jennifer Pai (Brigham and Women's Hospital, Boston, MA) and colleagues in their report, published online March 27, 2012 in the European Heart Journal. "For example, heavy alcohol intake decreases LVEF [left ventricular ejection fraction], increases blood pressure, and acutely inhibits fibrinolysis."

In healthy populations, moderate alcohol consumption is associated with a reduced risk of coronary heart disease, including a lower risk of cardiovascular and all-cause mortality. Given that post-MI patients are at an increased risk of reinfarction or sudden death, the researchers hypothesized the benefit of moderate alcohol consumption might extend to individuals with established heart disease. Previous studies have shown mixed results regarding the association between moderate alcohol consumption and mortality in patients with cardiovascular disease, however.

The new data are derived from an analysis of 1818 men diagnosed with incident MI in the Health Professionals Follow-up Study (HPFS). During long-term follow-up, 468 deaths were documented. Average alcohol consumption was calculated from the time period before the first MI and updated every four years using a food frequency questionnaire. Alcohol intake was measured by calculating the ethanol content in beer (12.8 g/bottle or can), wine (11.0 g/glass), and liquor (14.0 g/shot).

In the HPFS, after adjustment for body-mass index, physical activity, diabetes, hypertension, use of lipid-lowering medications, aspirin use, and heart failure at MI, consuming up to two drinks daily was associated with a significantly lower risk of total mortality and cardiovascular mortality. For those who consumed between 10 g to 29.9 g of alcohol per day, the risk of cardiovascular mortality was reduced 42%. For those who consumed more than 30 g/day, which translates into more than two drinks per day, the reduction in total and cardiovascular mortality was no longer statistically significant. There was no significant association between specific beverage type and mortality risk.

Long-Term Alcohol Consumption and Risk of Mortality

Alcohol consumption (g/day)

All-cause mortality, multivariate-adjusted hazard ratio (95% CI)

Cardiovascular mortality, multivariate-adjusted hazard ratio (95% CI)

No consumption

1.0 (reference)

1.0 (reference)

0.1-9.9

0.78 (0.62–0.97)

0.74 (0.54–1.02)

10.0-29.9

0.66 (0.51–0.86)

0.58 (0.39–0.84)

>30

0.87 (0.61–1.25)

0.98 (0.60–1.60)

Compared with nondrinkers, the reduction in total and cardiovascular mortality was statistically significant in patients with nonanterior MIs, but not for those with anterior MIs. Similarly, moderate alcohol consumption was also associated with a reduced risk of mortality among patients with normal or mildly diminished LVEF. The results suggest that the inverse association with alcohol consumption and mortality "may be weaker among men with a higher risk of subsequent mortality based on initial MI severity," write Pai and colleagues.

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