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Department of
Primary Care and Population Sciences, Royal Free and University College
Medical Schools, Rowland Hill Street, London NW3 2PF, UK
Correspondence to: Professor Shaper e-mail: agshaper{at}wentworth.u-net.com
Accepted 6 January
2000
OBJECTIVE
To
examine the effects of alcohol on risk of mortality from coronary heart
disease (CHD), cardiovascular disease, and all causes in men with
established CHD.
METHODS AND
RESULTSIn a population based prospective
study of 7169 men aged 45-64 years followed for a mean of 12.8 years,
655 men (9.1%) had a physician diagnosis of CHD (myocardial infarction
455, angina only 200). In these 655 men, there were 294 deaths from all
causes including 175 CHD deaths. Ex-drinkers had the highest risk of CHD, cardiovascular mortality, and all cause mortality even after adjustment for lifestyle characteristics and pre-existing disease. Using occasional drinkers as the reference group, lifelong
teetotallers, occasional drinkers, and light drinkers all showed
similar risks of mortality from CHD, cardiovascular disease, and all
causes. Moderate/heavy drinkers showed increased risk of mortality from CHD, cardiovascular disease, and all causes compared to occasional drinkers. The adverse effect of moderate/heavy drinking was confined to
the 455 men with previous myocardial infarction (adjusted relative risk
for all cause mortality 1.50, 95% confidence interval 1.01 to 2.23).
In contrast to lighter drinking, giving up smoking within five years of
the start of follow up was associated with a considerable reduction in
risk of all cause and cardiovascular mortality compared to those who
continued to smoke.
CONCLUSIONCompared
to occasional drinking, regular light alcohol consumption (1-14 units
per week) in men with established coronary heart disease is not
associated with any significant benefit or deleterious effect for CHD,
cardiovascular disease or all cause mortality. Higher levels of intake
(
3 drinks per day) are associated with increased mortality in men
with previous myocardial infarction. In contrast, smoking cessation in
men with established CHD substantially reduces the risk of mortality.
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