Light to moderate alcohol intake linked to lower total, CVD mortality in hypertensives

Boston, MA - Results of a new observational study suggest that light to moderate alcohol consumption is associated with a reduction in total and cardiovascular disease mortality among men with hypertension^[1].

The findings, from the Physicians' Health Study, appear in the March 22, 2004 issue of the Archives of Internal Medicine.

Although they require confirmation from other studies, the results appear to call into question a recently published American Heart Association Science Advisory that says those with hypertension should avoid alcoholic beverages, the authors suggest^[2].

"I think both patients and doctors alike have been squeamish about alcohol consumption in people with high blood pressure, but I think what this study says is that it's okay, and there may be some benefits," lead author Dr J Michael Gaziano (Brigham and Women's Hospital, VA Hospital, Harvard Medical School, Boston) told heartwire . First author on the paper is Maciej K Malinski (University of Massachusetts Medical School, Worcester).

Alcohol consistently linked to lower CV mortality

Heavy alcohol consumption has been shown in observational studies to raise blood pressure, and clinical studies have documented that when individuals who drink heavily reduce their intake, their blood pressure goes down, the researchers write. However, in the general population, moderate alcohol consumption has been consistently associated with reductions in cardiovascular mortality. Whether this is true among those with hypertension is "a largely unexamined and controversial question," Gaziano et al write.

In this study, they used data from the enrollment cohort of the Physicians' Health Study, a randomized trial of low-dose aspirin and beta-carotene. The cohort included over 88000 male physicians who provided self-reported information on their alcohol intake. From this large cohort, the researchers identified 14125 men with a history of current or past treatment of hypertension who were free of MI, stroke, cancer, or liver disease at baseline. They were followed for the occurrence of all-cause mortality or deaths deemed due to cardiovascular disease.

During 75710 person-years of follow-up, there were 1018 deaths, 579 from CVD. Compared with those who classified themselves as rare or never drinkers, subjects who reported monthly, weekly, or daily alcohol consumption had a decreasing risk of death, both for total mortality (p<0.001 for linear trend) and for CVD mortality (p<0.001 for linear trend).

Physicians Health Study: Multivariate adjusted relative risk of CVD mortality by reported alcohol consumption

To see whether this effect was based on blood-pressure control, they looked at men whose blood pressure was not controlled satisfactorily, ie, those with a systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher. The same trend was seen (p<0.001 for linear trend).

Physicians Health Study: Relative risk of CVD mortality by reported alcohol consumption among men with a measured systolic BP >140 mm Hg or diastolic BP >90 mm Hg

No significant association was seen between alcohol consumption and cancer risk (p=0.8 for linear trend).

"In light of major clinical and public-health problems associated with heavy drinking, recommendations regarding alcohol use must be made on an individual basis after carefully assessing cardiovascular risk profile and the risks and benefits of any changes in drinking behavior," Gaziano et al conclude. "However, patients with hypertension who are able to maintain light to moderate alcohol intake have no compelling reason to change their lifestyle and eliminate a possibly beneficial habit."

The authors note that these findings should be confirmed in other large-scale studies, but to heartwire , Gaziano said that he feels their findings can be interpreted "fairly definitively."

"We're always cautious about interpreting our studies, but these results are so similar to what we see in the general population that I think we can take these as more definitive than we would a study that's the first of its kind. This is in the context of about 100 or more other studies that have looked at alcohol in many populations around the world, and now, we're beginning to see this in certain disease populations," he noted. "We've published in diabetes, and people with known heart disease, and now in people with hypertension, that the good things alcohol does by raising the good cholesterol probably benefit all those groups of people. These are groups we have historically told to avoid alcohol consumption altogether, and I think that's not necessary anymore."

He noted though, that since some people for example, those with a personal or family history of alcoholism, those with conditions such as hepatitis C, or those on certain medicationsreally should not drink, patients should consult their doctor in deciding whether light to moderate alcohol consumption is a good choice for them.

Heartwire from Medscape © 2004 

Cite this: Light to moderate alcohol intake linked to lower total, CVD mortality in hypertensives - Medscape - Mar 22, 2004.