The purpose of this study was to evaluate whether beginning to drink moderately in middle age results in lower cardiovascular risk. This study examined a cohort of adults aged 45-64 years participating in the Atherosclerosis Risk in Communities study over a 10-year period. The primary outcome was fatal or nonfatal cardiovascular events.
Of 7,697 participants who had no history of cardiovascular disease and were non-drinkers at baseline, within a 6-year follow-up period, 6.0% began “moderate” alcohol consumption (2 drinks per day or fewer for men, 1 drink per day or fewer for women) and 0.4% began heavier drinking. After 4 years of follow up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did their persistently nondrinking counterparts. This difference persisted after adjustment for demographic and cardiovascular risk factors (odds ratio 0.62, 95% confidence interval, 0.40-0.95). There was no difference in all-cause mortality between the new drinkers and persistent non-drinkers (odds ratio 0.71, 95% confidence interval, 0.31-1.64).
The authors conclude that people who newly begin consuming alcohol in middle age rarely do so beyond recommended amounts. Those who begin drinking moderately experience a relatively prompt benefit of lower rates of cardiovascular disease morbidity with no change in mortality rates after 4 years.
Comments by professor R.Curtis Ellison: ‘We agree with the introductory statements of the authors that while observational data strongly indicate that middle-aged or older people who report moderate alcohol consumption have better health outcomes than abstainers, almost no health or policy agencies encourage advising non-drinkers to begin drinking. The only governmental agency to actually suggest this was the Sensible Guidelines for Drinking from the UK in 1995, and this report raised considerable concern among many physicians. The concern is apparently that any advice to begin to drink moderately will start someone on the “slippery slope” leading to alcoholism. However, there are essentially no data supporting this assertion.
In several previous reports from observational studies (including the Physicians’ Health Study and the San Antonio Heart Study), it has been shown that subjects who stop drinking between examinations tend to subsequently show higher rates of cardiovascular disease and death, while those who newly report alcohol consumption tend to have better health. The present study supports this contention, showing that subjects who reported no alcohol intake at a baseline examination but moderate intake at a later examination had a lower subsequent risk of cardiovascular disease than those who remained non-drinkers.
A weakness of this study is that subjects did not give data on alcohol intake prior to the baseline exam, so it is possible that there were some ex-drinkers included in the baseline non-drinking group; this could have made the apparent alcohol effects underestimated (if these subjects subsequently began to drink again) or overestimated (if they remained non-drinkers at exam 3). Ex-drinkers should not be included in a non-drinker referent group, as they generally have higher risk of disease and death than lifetime abstainers. Further, the follow-up period of only 4 years is too short to detect occurrences of cancer or other potential adverse effects of initiating drinking that might show up later. It is also too short for meaningful analyses of mortality.
Our Institute is currently completing analyses based on more than 800 (of the 5,209) subjects in the Framingham Cohort Study who reported “never drinking” at the baseline examination in 1948-1952. Of these presumably lifetime abstainers up to that point, approximately one-half began to consume alcohol later. The effects on mortality over more than 50 years will be known soon, so the risks can be compared between persistent non-drinkers and subjects beginning to drink during adulthood. We will also be able to estimate the long-term risks of developing an alcohol use disorder among these adult-onset drinkers’.
Source: King DE, Mainous AG III, Geesey ME. Adopting moderate alcohol consumption in middle age: Subsequent cardiovascular events. Am J Med 2008;121:201-206.