Changes in Alcohol Intake and Subsequent Health Outcomes

To
assess how changes in drinking over time may impact coronary
heart disease (CHD), stroke, and all-cause mortality,
investigators analyzed data from 6544 middle-aged, healthy
British men who had participated in a 20-year prospective
study on cardiovascular health. During follow-up, 922
men died from CHD or had a nonfatal myocardial infarction,
352 had a stroke, and 1552 died from all causes.

• The
  relationship between alcohol intake at study entry and
  the risks of CHD, stroke, and all-cause mortality was
  generally U-shaped, with the lowest risk for subjects
  who consumed 1-2 drinks per day or 1-6 drinks per day
  only on the weekends.
• In
  analyses that averaged consumption during follow-up
  (to account for intake over time), the benefits of lighter
  drinking and the risks of heavier drinking increased.
  Further, the risks of nondrinking decreased.

Comments:

It
is laudable to try to account for drinking, and changes
in drinking, over time when assessing how alcohol use
influences health outcomes. However, the results of this
study are difficult to interpret for two major reasons.
First, by using one value of “average” intake, investigators
cannot accurately assess the effects of changes in drinking
over time. Second, grouping subjects who drank small amounts
regularly without bingeing with subjects who were weekend
bingers is problematic. Researchers should be encouraged
to study changes in alcohol intake over time, using appropriate
methods, so we can better understand the effects of alcohol
on CHD, stroke, and mortality.

R.
Curt Ellison, MD

Reference:

Emberson
JR, Shaper AG, Wannamethee SG, et al. Alcohol intake in
middle age and risk of cardiovascular disease and mortality:
accounting for intake variation over time. Am J Epidemiol.
2005;161(9):856-863.