CARDIOVASCULAR MEDICINE

Taking up regular drinking in middle age: effect on major coronary heart disease events and mortality

S G Wannamethee, A G Shaper

Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF, UK

Correspondence to:
Correspondence to:
Dr S G Wannamethee, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF, UK;
goya{at}pcps.ucl.ac.uk

Aim: To examine effects of taking up regular drinking by middle aged non-drinkers and occasional drinkers on major coronary heart disease events and total mortality.

Methods: A prospective study of 7735 men from general practices in 24 British towns screened in 1978–80 at age 40–59 years (Q1). Five years after screening, 7157 men then aged 45–64 completed postal questionnaires (Q5) on changes in alcohol intake.

Results: In 6503 men without diagnosed coronary heart disease, there were 874 major coronary heart disease events and 1613 total deaths during 16.8 years of follow up after Q5. With stable occasional drinkers as baseline, men who continued to drink regularly had a significantly lower risk of major coronary heart disease events, coronary heart disease mortality, and overall cardiovascular mortality, but a slightly increased risk of non-cardiovascular mortality. New regular drinkers (89% light), even after adjustment for their many advantageous characteristics, showed a lower risk of major coronary heart disease events than stable occasional drinkers (relative risk (RR) = 0.70; 95% confidence interval (CI) 0.48 to 1.03; p = 0.07). New drinkers showed no reduction in coronary heart disease or cardiovascular mortality and experienced an increase in risk of non-cardiovascular mortality (RR = 1.40; 95% CI 0.99 to 1.97; p = 0.06). In 654 men with diagnosed coronary heart disease, new drinkers experienced no mortality benefit compared with stable occasional drinkers.

Conclusions: Middle aged new regular drinkers experienced lower risk of major coronary heart disease events than stable occasional drinkers or non-drinkers, but had increased risk of non-cardiovascular mortality and total mortality. These findings provide little support for encouraging older men who do not drink or who only drink occasionally to take up regular drinking, whether or not they have coronary heart disease.

Keywords: alcohol; drinking; coronary heart disease; mortality

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