There is no doubt that the light to moderate consumption of alcohol,
compared with abstention, can confer a protective effect for cardiovascular
disease and indeed reduce the risk of death from all causes (Klatsky
et al. 1992, Holman et al. 1996). It has generally been suggested
that this protective effect is first observed when risk factors
for cardiovascular disease begin to influence medium and long-term
health, that is, at approximately age 40 years for men and approximately
age 50 years for women, where in women the effect depends on the
age of onset of menopause and use of hormone replacement therapy
(Stampfer et al. 1988. Klatsky et al. 1992, 1996, Rehm and Sempos
1995). There is also data, which suggests that the consumption
of alcohol at a younger age does positively influence the risk
of cardiovascular disease at a later age (Power et al. 1998).
This relationship is important given that cardiovascular disease
accounts for approximately 2550% of all deaths in developed countries,
and given the increasing incidence of cardiovascular disease in
developing countries, which may reflect the increasing standard
of living in these countries (Bennett and Magnus 1994, Tunstall-Pedoe
et al. 1994, 1997).
Concerning elderly populations, the relationship between alcohol
consumption and mortality has been less well documented. Indeed,
it has been postulated that any cardioprotective effect for cardiovascular
disease may be negated by increased morbidity and mortality from
other causes (Van de Water and Boshuizen 1995). For example, although
two US cohort studies have shown that light to moderate alcohol
consumption in men and women aged over 65 years may be associated
with a reduced risk of all-cause mortality by 3040%, a third study
has shown no such association (Scherr et al. 1992, Brandt et al.
1993, Holbrook and Barrett-Connor 1993). The two former studies
observed, however, significant differences in cognitive function
or mental performance and greater bone density (which is major
cause of disability), in addition to a reduced risk of mortality
from cardiovascular disease.
An ongoing prospective Australian study entitled the Dubbo Study
of the Elderly is, however, examining this relationship between
alcohol consumption and mortality in an elderly and aging population.
The study commenced in 1988/89, and 1235 men and 1570 women have
participated. Of these, regular alcohol consumption was reported
by 78% of the men and 52% of the women. The baseline examinations
comprised demographic, psychosocial and standard cardiovascular
risk assessments, including an examination of fasting blood (Simons
et al. 1991). Questions on alcohol consumption were those prepared
for the National Heart Foundation Risk Factor Prevalence Study,
giving an approximation of regular consumption grouped as zero,
one to seven, eight to 14, 15 to 28 and greater than 28 standard
drinks per week, where a standard drink refers to 10 g alcohol
(Risk Factor Prevalence Study Management Committee 1990).
This study was first reported in 1996 (Simons et al. 1996), where
after 77 months of follow-up, it was shown that alcohol intake
in the Dubbo elderly appeared to be independently associated with
a significant increase in life expectancy, for example, by approximately
51% for both men and women, compared with their abstaining counterparts.
For women only, however, the increase was less significant when
alcohol consumption was greater than 14 drinks per week. This
increase in life expectancy was primarily related to a decreased
risk of cardiovascular disease while that of cancer and liver
cirrhosis increased, but to a lesser or less significant extent.
After 116 months follow-up in 1997/98, further information is
emerging concerning the elderly Dubbo population and the effects
of their alcohol consumption. For example, any alcohol consumption
still appeared to be associated with a significant increase in
life expectancy in men, but only until 74 years of age. In women,
however, the reduced risk of all-cause mortality continued with
increasing age over 74 years, but still only when consumption
was less than 14 drinks per week; this is a demonstration of the
oft described J-shaped relationship between alcohol consumption
and risk of cardiovascular disease and all-cause mortality compared
to an inverse relationship observed for men. By the end of almost
10 years follow-up, men consuming any alcohol lived 7.6 months
longer and women lived 2.7 months longer than their abstaining
counterparts. Follow-up is continuing, and also assesses other
predictors of mortality and morbidity.
Brandt, J., Welsh, K.A., Breitner, J.C., Folstein, M.F., Helms,
M., Christian, J.C. Hereditary influences on cognitive functioning
in older men. A study of 4000 twin pairs. Archives Neurology 50(6):599603;
Holdbrook, T.L., Barrett-Connor, E. A prospective study of alcohol
consumption and bone mineral density. Br. Med. J. 306:15061509;
Holman, C.D.J, English, D.R., Milne, E., Winter, M.G. Meta-analysis
of alcohol and all-causes mortality: a validation of NH&MRC recommendations.
Med. J. Aust. 164:141145; 1996.
Klatsky, A.L.; Armstrong, M.A.; Friedman, G.D. Alcohol and mortality.
Ann. Intern. Med. 117(8):646-654; 1992.
Klatsky, A.L. Alcohol, coronary disease and hypertension. Ann.
Rev. Med. 47149160; 1996.
Power, C., Rodgers, B., Hope, S. U-shaped relation for alcohol
consumption and health in early adulthood and implications for
mortality. Lancet 352: 877; 1998.
Rehm J, Sempos CT. Alcohol consumption and all-cause mortality.
Addiction 90: 471480; 1995.
Risk Factor Prevalence Study Management Committee. Risk Factor
Prevalence Study: Survey No.3, 1989. Canberra: National Heart
Foundation of Australia and Australian Institute if Health; 1990.
Scherr, P.A., LaCroix, A.Z., Wallace, R.B. et al. Light to moderate
alcohol consumption and mortality in the elderly. J. Am Geriatr.
Soc. 40:651657; 1992.
Simons, L.A. Alcohol and the elderly: lessons from the Dubbo Study
of the Elderly. In: Proceedings of The 1999 conference the International
Medical Advisory Group, 46 October 1999; Melbourne, Victoria,
Australia; 2000. Pp 256264.
Simons, L.A., McCallum, J., Friedlander, Y., Simons, J., Powell,
I., Heller, R. Dubbo study of the elderly: sociological and cardiovascular
risk factors at entry. Aust. N.Z. J. Med. 21:701709; 1991.
Simons, L.A., McCallum, J., Friedlander, Y., Simons, J. Alcohol
intake and survival in the elderly: a 77 month follow-up in the
Dubbo study. Aust. N.Z. J. Med. 26:662670; 1996.
Stampfer, M.J., Colditz, G.A., Willett, W.C., Speizer, F.E., Hennekens,
C.H. A prospective study of moderate alcohol consumption and the
risk of coronary disease and stroke in women. N. Eng. J. Med.
319: 267273; 1988.
Tunstall-Pedoe, H., Kuulasmaa, K., Amouyel, P., Arvellier, D.,
Rajakangas, A.M., Pajal, A. Myocardial infarction and coronary
deaths in the World Health Organisation MONICA project: Registration
procedures, event rates and case fatality rates in 38 populations
from 21 countries in four continents. Circulation 90:583612; 1994.
Tunstall-Pedoe, H., Woodward, M., Tavendale, R., A'Brook, R.,
McCluskey, M.K. Comparison of the prediction by 27 different factors
of coronary heart disease and death in men and women of the Scottish
heart healthy study: cohort study. Br. Med. J. 315:722729; 1997.
Van de Water, H.A., Boshuizen, H.C. The impact of substitute morbidity
and mortality on public health policy. Leiden: TNA Prevention
and Health, Division of Public Health and Prevention; 1995.