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The controversy about alcohol and cardiovascular health remains
If you can’t stop smoking shouldn’t you have a drink or two?
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Erlon O. de Abreu Silva, MD Division of Internal Medicine, Complexo Hospitalar Santa Casa de Porto Alegre
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erlon{at}terra.com.br Erlon O. de Abreu Silva
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In the article written by Beulens et al (1), published in the Annals, the authors affirm that moderate alcohol consumption is associated with a decreased risk of myocardial infarction (MI) in hypertensive men. However, some considerations must be made. The hazard ratio of drinking 15 to 29.9g of alcohol per day was statistically significant in the multivariate analysis only for total MI (CI for fatal coronary heart disease - CHD - is 0.50-1.25; and for non- fatal MI, 0.46-1.03). People in this range of alcohol consumption had the highest physical activity index and the largest absolute number of former smokers. These two characteristics are indicators of a healthier lifestyle, reflecting actions capable of lowering the cardiovascular risk per se. Fuchs et al (2) found a positive relationship between alcohol consumption and incident CHD for African-american men, but not for Caucasians. In that study there were a higher prevalence of hypertension and lower socio-economic status in non-whites, suggesting moderate to abusive alcohol consumption as a behavioral marker of lifestyle characteristics that would put these individuals in greater cardiovascular risk. These conflicting data keep the discussion about actual cardioprotective properties of alcohol and the possibility to quantify it. Until a consent about this subject is achieved, physicians should concentrate efforts in lowering cardiovascular risk with the known and well-established strategies, as controlling blood pressure and other risk factors for CHD and stroke. References 1- Beulens JWJ; Rimm EB; Ascherio A; et al. Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension. Ann Intern Med. 2007;146:10-19. 2- Fuchs FD, Chambless LE, Folsom AR, et al. Association between alcoholic beverage and incidence of coronary heart disease in whites and blacks. The Atherosclerosis Risk in Communities Study. Am J Epidemiol 2004; 160(5):466-74 Conflict of Interest:None declared |
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Dan L Musat, MD St. Luke's Roosevelt, New York, NY, Sripal Bangalore, MD, and Franz H. Messerli, MD
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dmusat{at}chpnet.org Dan L Musat, et al.
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The authors are to be commended to have carried out a thorough study documenting a progressively lower risk of myocardial infarction with increasing alcohol intake. (1) Surprisingly, they failed to comment on their observation that smoking also increased in parallel with alcohol intake. In fact, though there was a 307% increase in the incidence of smoking in the group with the highest alcohol consumption, the risk of myocardial infarction was reduced by 57% in this group compared with non-drinkers. Could this apparent “paradox” possibly indicate that alcohol consumption, by mechanisms that authors described (increase in high-density lipoprotein cholesterol, decrease of inflammatory factors, improved insulin sensitivity, and change of thrombogenic markers), antagonizes the detrimental effects of smoking on coronary artery disease as has been suggested also by other observational studies? (2-5) If so, should we not perhaps advise our patients who are unable or unwilling to give up smoking to at least have a drink or 2 in order to protect their coronaries? And if so, does it matter whether these two drinks are red wine, as French authors recommend, or liquor, as present paper seems to entail? References: 1. Beulens JW, Rimm EB, Ascherio A, Spiegelman D, Hendriks HF, Mukamal KJ. Alcohol consumption and risk for coronary heart disease among men with hypertension. Ann Intern Med. 2007;146(1):10-9. 2. Goldberg RJ, Burchfiel CM, Reed DM, Wergowske G, Chiu D. A prospective study of the health effects of alcohol consumption in middle-aged and elderly men. The Honolulu Heart Program. Circulation. 1994;89(2):651-9. 3. Solomon CG, Hu FB, Stampfer MJ, et al. Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation. 2000;102(5):494-9. 4. Tanasescu M, Hu FB, Willett WC, Stampfer MJ, Rimm EB. Alcohol consumption and risk of coronary heart disease among men with type 2 diabetes mellitus. J Am Coll Cardiol. 2001;38(7):1836-42. 5. Valmadrid CT, Klein R, Moss SE, Klein BE, Cruickshanks KJ. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. Jama. 1999;282(3):239-46. Conflict of Interest:None declared |
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