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Alcohol and coronary artery calcium prevalence, incidence, and progression
The authors of a new study state that alcohol use has been consistently found to have a J-shaped association with coronary heart disease, with moderate drinkers exhibiting a decreased risk compared with both heavy drinkers and nondrinkers. The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective community-based cohort study of subclinical cardiovascular disease in a multi-ethnic cohort. In 2000–2002, 6,814 participants free of clinical cardiovascular disease were enrolled at 6 participating centers.

The subjects consisted of 3,766 (55.5%) current drinkers, 1,635 (24.1%) former drinkers, and 1,390 (20.5%) never drinkers. Although light-to-moderate alcohol consumption was associated with lower coronary heart disease risk, the investigators found no evidence of a protective or J-shaped association of alcohol and coronary artery calcium (CAC). In fact, there was evidence that heavy consumption of hard liquor was associated with greater CAC accumulation. Other alcoholic beverages were not associated with CAC prevalence, incidence, or progression. The authors conclude that this was the first large study to evaluate the association of alcohol with CAC in 4 racial-ethnic groups and to evaluate the progression of calcification. These results suggest that the cardiovascular benefits that may be derived from light-to-moderate alcohol consumption are not mediated through reduced CAC accumulation.

Professor R Curtis Ellison comments: ‘The group carried out an analysis of alcohol and CAC in the Family Heart Study a few years ago and found no association; the present study supports these findings. While moderate drinkers in MESA showed a strong inverse association with the occurrence of coronary heart disease (approximately 60% lower risk for consumers of 1 - 2 drinks/day in comparison with life-time abstainers), the authors found that alcohol intake did not lower measured levels of CAC or progression of the degree of CAC over time. There was a suggestion that higher intake of alcohol, especially of spirits, could lead to an increase in calcification.

In conjunction with previous research, the new findings suggest that the potential protection against myocardial infarction from moderate alcohol intake may be related more to clotting mechanisms, or to direct effects on the blood vessel lining (the endothelium), than to the development of calcification within the coronary arteries’.

Source: McClelland RL et al. Alcohol and coronary artery calcium prevalence, incidence, and progression: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 2008;88:1593–1601.

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