Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension

2 January 2007 | Volume 146 Issue 1 | Pages 10-19

Background: Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce.

Objective: To assess whether alcohol consumption is inversely associated with CVD among men with hypertension.

Design: Prospective cohort study.

Setting: United States.

Participants: 11 711 men with hypertension from the Health Professionals Follow-Up Study.

Measurements: Alcohol consumption was assessed every 4 years by using a food-frequency questionnaire. Incident cases of nonfatal myocardial infarction (MI), fatal coronary heart disease, and stroke were documented from 1986 to 2002.

Results: During follow-up, 653 patients with MI were documented. Compared with patients abstaining from alcohol, the hazard ratio for participants with MI consuming 0.1 to 4.9 grams of alcohol per day was 1.09 (95% CI, 0.86 to 1.37); consuming 5 to 9.9 grams of alcohol per day was 0.81 (CI, 0.60 to 1.08 g/d); consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72 (CI, 0.54 to 0.97 g/d); consuming 30 to 49.9 grams of alcohol per day was 0.67 (CI, 0.48 to 0.94 g/d); and consuming 50 or more grams of alcohol per day was 0.41 (CI, 0.22 to 0.77 g/d) (P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 (CI, 0.93 to 2.12) and 1.55 (CI, 0.90 to 2.68) compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68 (CI, 0.46 to 1.00).

Limitations: Hypertension, alcohol consumption, and CVD risk factors were assessed by self-report. Available data used to correct for measurement error were primarily restricted to dietary variables.

Conclusions: In this population of men with hypertension, moderate alcohol consumption was associated with a decreased risk for MI but not with risks for total death or death due to CVD. As in the general population, men with hypertension who drink moderately and safely may not need to change their drinking habits.

Editors' Notes Context Heavy alcohol consumption may increase risk for hypertension, but does it increase risk for cardiovascular disease? Contributions In this 16-year prospective study, 11 711 male health professionals with hypertension reported their average alcohol consumption every 4 years. Compared with men who abstained from alcohol, men who consumed 10 to 14 g/d (about 1 drink per day), 15 to 29 g/d, 30 to 49 g/d, and more than 49 g/d of alcohol had decreased risk for myocardial infarction. Alcohol intake seemed unrelated to total death or death due to cardiovascular disease. Cautions Alcohol intake and hypertension were self-reported. Few outcomes limited ability to determine precise relationships between alcohol and stroke. —The Editors

 

Author and Article Information

From the Harvard School of Public Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts; the Wageningen University, Wageningen, The Netherlands; and TNO Quality of Life, Zeist, The Netherlands.

Acknowledgments: The authors thank Meir J. Stampfer for his valuable comments on the editing of the manuscript.

Grant Support: By National Institutes of Health Grants AA11181, HL35464, and CA55075; a travel grant from the Dutch Heart Association; and a research exchange award from European Research Advisory Board.

Potential Financial Conflicts of Interest: Dr. Rimm has an annual speaking engagement at an academic conference for which the trip is sponsored by Distilled Spirits Council of the United States.

Requests for Single Reprints: Joline W.J. Beulens, MSc, University Medical Center, Utrecht Julius Center for Health Sciences and Primary Care, PO Box 85500, 3508 GA Utrecht, The Netherlands; e-mail, J.Beulens{at}umcutrecht.nl.

Current Author Addresses: Dr. Beulens: University Medical Center Utrecht Julius Center for Health Sciences and Primary Care, PO Box 85500, 3508 GA Utrecht, The Netherlands.

Drs. Rimm and Ascherio: Department of Nutrition, Harvard School of Public Health, Building II, 655 Huntington Avenue, Boston, MA 02115.

Dr. Spiegelman: Department of Biostatistics, Kresge Building, Room 806, 677 Huntington Avenue, Boston, MA 02115.

Dr. Hendriks: Business Unit Biosciences, TNO Quality of Life, PO Box 360, 3700 AJ Zeist, The Netherlands.

Dr. Mukamal: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215.

Author Contributions: Conception and design: J.W.J. Beulens, E.B. Rimm, A. Ascherio, H.F.J. Hendriks, K.J. Mukamal.

Analysis and interpretation of the data: J.W.J. Beulens, A. Ascherio, D. Spiegelman, K.J. Mukamal.

Critical revision of the article for important intellectual content: J.W.J. Beulens, E.B. Rimm, A. Ascherio, D. Spiegelman, H.F.J. Hendriks, K.J. Mukamal.

Final approval of the article: J.W.J. Beulens, E.B. Rimm, A. Ascherio, H.F.J. Hendriks, K.J. Mukamal.

Provision of study materials or patients: E.B. Rimm, D. Spiegelman.

Statistical expertise: D. Spiegelman.

Obtaining of funding: J.W.J. Beulens, E.B. Rimm, D. Spiegelman, H.F.J. Hendriks, K.J. Mukamal.

Collection and assembly of data: E.B. Rimm, D. Spiegelman.

Read all Rapid Responses

If you can’t stop smoking shouldn’t you have a drink or two?

Dan L Musat, et al.

Annals Online, 1 Feb 2007 [Full text]

The controversy about alcohol and cardiovascular health remains

Erlon O. de Abreu Silva

Annals Online, 15 Feb 2007 [Full text]