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Exploring the relationship between alcohol consumption and risk of mortality in the elderly
Creina S. Stockley, Health and Regulatory Information Manager, The Australian Wine Research Institute
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.

References

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