Lower Risk of Heart Disease from Alcohol, Even with Hazardous Drinking?

Researchers assessed the relationship between coronary heart disease (CHD) and alcohol consumption using data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions study (NESARC, n=43,093). The sample included 16,147 people who were abstinent, 15,884 who drank moderate amounts, 9578 who drank hazardous amounts, and 1484 who were alcohol dependent.* Participants were asked whether they had CHD in the last 12 months as confirmed by a doctor.

Both moderate and hazardous drinking were associated with decreased odds of CHD when compared with abstinence, whereas odds of CHD were not significantly different between abstinent and alcohol-dependent participants.

In multivariable analyses controlling for sociodemographic, psychiatric, and addictive risk factors, both moderate and hazardous drinking were associated with a decreased likelihood of CHD.

*Moderate drinking was defined as having at least 1 drink in the past year but not meeting criteria for hazardous drinking or dependence. Hazardous drinking was defined as exceeding weekly limits (men, >14 drinks per week; women, >7 drinks per week) or exceeding daily limits (men, ≥5 drinks per day; women, ≥4 drinks per day) in the past year. Dependence was diagnosed using DSM-IV criteria.

Comments:

The authors conclude that alcohol may be cardioprotective not only in individuals who drink moderately but also in those who drink amounts traditionally considered to be hazardous. However, the method used to diagnose CHD raises concerns: only 1% of subjects reported having had myocardial infarction in the past year, the primary “hard” endpoint for CHD, whereas most reported angina pectoris, a “softer” endpoint for CHD. Further, subjects who quit drinking due to illness or those with hazardous drinking who died earlier than healthy subjects may have confounded results. Another possibility is that the definition of “hazardous drinking” in this study was too inclusive, including some people who might better be classified as moderate drinkers. If indeed hazardous drinking does not increase the risk of CHD, it is possible that the increase in cardiovascular disease from heavy drinking reported in other studies may be due to arrhythmias, cardiomyopathy, or other effects of alcohol, and not from coronary artery disease.

R. Curtis Ellison, MD

Reference:

Le Strat Y, Gorwood P. Hazardous drinking is associated with a lower risk of coronary heart disease: Results from a national representative sample. Am J Addict. 2011;20(3):257–263.

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