Moderate Drinking After MI Shows Mortality Benefit

COLORADO SPRINGS — Moderate alcohol consumption following a first nonfatal acute MI appeared to protect against cardiovascular and all-cause mortality in the Physicians' Health Study.

This protective effect of moderate drinking was most robust among male physicians who had a nonanterior MI, reported Jennifer K. Pai, Sc.D., of the Harvard School of Public Health, Boston.

Numerous studies have documented a link between moderate alcohol intake and lower risk of coronary heart disease in healthy individuals. But there have been few data on the impact of drinking after a first MI.

To remedy that situation, Dr. Pai and her coinvestigators turned to the Physicians' Health Study, a landmark National Institutes of Health-sponsored prospective cohort study involving more than 20,000 male physicians begun 26 years ago, she reported at a conference sponsored by the American Heart Association.

Alcohol consumption data were available on 1,879 physicians immediately before they experienced a first nonfatal acute MI sometime after 1986. The drinking data were updated every 4 years afterward through 2004, at which point there were 317 deaths.

Physicians were classified into four groups on the basis of their pattern of alcohol use: an average of 0.1–9.9 g of alcohol per day, 10.0–29.9 g/day, 30 g or more/day, and nondrinkers. An alcoholic beverage typically contains 7–12 g of alcohol.

Upon multivariate adjustment for demographic factors, cardiovascular risk factors, and detailed information on MI severity and treatment, the relative risk of all-cause mortality in physicians who drank up to 9.9 g of alcohol/day after their MI was reduced by 34%, compared with the nondrinkers. Among physicians who averaged 10.0–29.9 g/day, the relative risk reduction was 40%. For heavier drinkers, the all-cause mortality risk reduction was 30%.

For cardiovascular mortality, the adjusted relative risk reductions were 34%, 48%, and 31%, respectively, for the lightest to heaviest drinkers, compared with nondrinkers, Dr. Pai continued.

The magnitude of the mortality benefit associated with post-MI alcohol consumption tended to be less among physicians with anterior MI than in those with MIs involving other sites.