Drinking Pattern and Beverage Type Modify Alcohol’s Effect on Risk of Coronary Disease

To investigate the effect of drinking patterns on ischemic heart disease in 2 countries (Northern Ireland and France), researchers compared alcohol consumption, heavy episodic (“binge”) drinking,* regular drinking,† consumption frequency, and type of beverage consumed 1 week prior to baseline examination with 10-year risk of hard coronary events (myocardial infarction or coronary death) and angina. The sample included 9778 men from Belfast or 1 of 3 French cities. Participants were aged 50–59 and free of ischemic heart disease at baseline.

• Overall, 60.5% of participants from Belfast and 90.6% from France reported drinking alcohol at least once a week. Of those who drank, 12% in Belfast drank every day compared with 75% in France.

• Mean alcohol consumption was 22 g per day in Belfast and 33 g per day in France. Binge drinking was reported by 9.4% of Belfast participants and 0.5% of French participants.

• The annual incidence of hard coronary events (n=322) per 1000 person-years was 5.63 in Belfast and 2.78 in France.

• In adjusted analyses, compared with regular drinkers, the hazard ratio (HR) for hard coronary events was 1.97 for binge drinkers, 2.03 for never drinkers, and 1.57 for former drinkers across the sample.

• Compared with participants in France, the HR for hard coronary events among Belfast participants was 1.76, which dropped to 1.09 after adjusting for drinking pattern and wine drinking. Only wine drinking was associated with a lower risk of hard coronary events, irrespective of country.

Comments:

Although a strong inverse association between moderate alcohol consumption and cardiovascular disease (CVD) has been demonstrated for decades, more recent research has emphasized the importance of drinking pattern (regular moderate consumption versus episodic or binge drinking). This study addressed drinking pattern, but it is entirely based on drinking during 1 week as the exposure—a substantial methodological limitation. Nonetheless, it may inform the debate about the potential greater effect of moderate wine consumption versus other alcoholic beverages on CVD risk. The main finding was that regular moderate drinking, especially of wine, lowered CVD risk, while binge drinking, especially of beer or whiskey, increased it.

R. Curtis Ellison, MD

Reference:

Ruidavets JB, Ducimetière P, Evans A, et al. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ. 2010:23;341:c6077.