Possible Cardioprotection from Moderate Drinking Limited to People with Other Unhealthy Behaviors
Although observational studies have found moderate drinking reduces the risk of myocardial infarction (MI), less is known about whether such benefits are limited to a select few. In a prospective study, researchers in England followed 9655 middle-aged adult civil servants with no MI at baseline for a median of 17 years. Subjects were characterized according to unhealthy behavior.
- Among people reporting regular physical activity, daily fruit and vegetable consumption, and no smoking, moderate alcohol use (<1 to 8 or 9 standard [14 g] US drinks per week), compared with no use or heavier use, had no effect on the incidence of fatal coronary heart disease (CHD) or nonfatal MI in analyses adjusted for age, sex, and socioeconomic status.
- Moderate use was associated with half the risk of CHD among people with 2 or 3 unhealthy behaviors.
- Analyses adjusted for diabetes, angina, hypertension, and cardiovascular medication use yielded similar results.
Even if moderate drinking reduces CHD (a hypothesis not yet confirmed in clinical trials), in this study it had no such benefit for people who exercise, eat fruits and vegetables, and do not smoke. The authors recommend that the variability in the effect of moderate drinking, typically overlooked, must be emphasized in public health messages and advice regarding alcohol use. However, because drinking was assessed at only one point in time, available adjustment variables were limited, and some important subgroups were small (e.g., 8 CHD events among healthy nondrinkers), these results should by no means be considered definitive.
Richard Saitz, MD, MPH