Summary: The authors state that prior studies show light to moderate alcohol use is associated with reduced mortality and cardiovascular events, whereas heavy use increases mortality and cardiovascular risks. The association of alcohol use and post-myocardial infarction (MI) symptoms is unknown. They explored the association between alcohol use and risk of having angina 1 year after an MI. Upon enrollment in the 19-centre prospective PREMIER registry, acute MI patients (n=2,481) were asked about alcohol use. Angina (any vs. none) was assessed at 1 year with the Seattle Angina Questionnaire. The association of alcohol use and 1-year angina was modeled using a hierarchical multivariable modified Poisson regression model.
Results indicated that 47% reported never drinking and others reported having the following number of drinks/day: 42% < 1; 6% 1 to 2; 3% > 2 to 4; 2% > 4. After adjusting for demographic, clinical, and treatment variables, patients who reported never drinking were 45% more likely to have angina than moderate drinkers (1 to 2 drinks/day). However, > 4 drinks/day was associated with an 81% greater risk of angina than moderate alcohol use. Those drinking < 1 drink/day or > 2 to 4 per day had similar angina risk compared to moderate drinkers. Results did not vary by gender (p > .05 for interaction). The authors conclude that this study extends prior evidence of a dose-dependent relationship between alcohol use and other cardiovascular benefits/risks to post-MI angina. Moderate alcohol consumption (1 to 2 drinks/day) was associated with reduced risk of angina 1 year after MI compared to abstinence or heavy alcohol consumption. Excessive alcohol use (> 4 drinks/day) was associated with increased risk of angina.
Comments: In this study of subjects who had had a MI, there appeared to be a reduction in the risk of angina among consumers of alcohol of up to 4 drinks per day, but a significant increase in risk for those consuming more. In the above figure, the risk was lowest for those consuming 2-4 drinks/day, but it was stated in the presentation that the percentage of subjects reporting angina was essentially the same for all subjects consuming between 1 and 4 drinks/day. The risk was higher, however, for “binge drinkers,” defined in this study as consuming 6 or more per occasion at least once a month: 34% higher than non-bingers for men, 55% higher than non-bingers for women.
In the presentation, the speaker said that the study also evaluated level of physical functioning, using the SF12 PCS instrument. As with angina, the highest risk of a poor functioning score was among abstainers and heavy drinkers. This study supports limited data on the effect of alcohol intake among people who have had a MI. From both the functioning point of view and for angina, the moderate drinkers had the best outcomes.
Alcohol consumption and one-year angina risk after myocardial infarction. Buchanan DM, Mundluru S, O’Keefe JH, Reid KJ . . . . Spertus JA. Abstracts related to alcohol consumption from the scientific sessions of the American Heart Association, October 4-7, 2007 reviewed by R Curtis Ellison Abst 3586