Elsevier

The Lancet

Volume 360, Issue 9344, 9 November 2002, Pages 1448-1454
The Lancet

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Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study

https://doi.org/10.1016/S0140-6736(02)11470-XGet rights and content

Summary

Background

Moderate alcohol consumption is associated with reduced cardiovascular mortality, but binge drinking is thought to be detrimental. We examined effects of heavy and binge drinking in a population with high rates of binge drinking.

Methods

We did a prospective cohort study in Novosibirsk, Russia, in 6502 men aged 25–64 years at baseline who were examined in WHO MONICA (monitoring trends and determinants in cardiovascular disease surveys) in 1985/86, 1988/89, and 1994/95, and in a pilot study in 1984. We assessed alcohol intake and drinking pattern by questionnaire; binge drinking was defined as consumption of 160 g or greater of pure alcohol on a typical occasion. Participants were followed—up for a median of 9·5 years (range 3·1–15·2).

Findings

There were 836 deaths in the cohort, 395 of which resulted from cardiovascular diseases. Prevalence of binge drinking at baseline was 16% (n=1005). Adjusted relative risks for binge drinking at least once a month (compared with consumption of <80 g pure alcohol) were 1·05 (95% Cl 0·80–1·36) for deaths from all causes, 0·99 (0·66–1·50) for deaths from cardiovascular disease, 1·27 (0·81–1·99) for deaths from coronary heart disease, and 2·08 (1·08–3·99) for death from external causes. Risk of total and cardiovascular mortality was raised in a small group of frequent heavy drinkers (5% [264] of all drinkers); for this group, adjusted relative risks were 1·61 (1·04–2·50) for total mortality and 2·05 (1·09–3·86) for deaths from cardiovascular disease.

Interpretation

The risk of death from cardiovascular disease seems to be increased in frequent heavy drinkers, but is not necessarily associated with episodic binge drinking.

Introduction

Investigators have repeatedly shown that there is a U—shaped or J—shaped association between regular moderate alcohol intake and all—cause mortality, and that the risk of coronary heart disease is reduced in moderate drinkers.1, 2, 3 Attention now turns to the pattern of drinking,4 and some investigators have noted an absence of understanding of the effects of heavy regular drinking or binge drinking on cardiovascular risk.5, 6 Evidence is emerging that heavy or binge drinking could have different effects from moderate drinking and might increase cardiovascular mortality,6, 7, 8 but very few investigators have examined specifically binge drinking.

This issue is of fundamental importance for public health policy in Russia. Shkolnikov and colleagues9, 10 have proposed that the striking fluctuations in death rates in Russia between 1985 and 1994 were largely caused by alcohol consumption. According to this theory, the acute effects of binge drinking, the drinking pattern common in Russia,11, 12, 13 include increased risk of death not only from accidents, violence, and other causes directly related to alcohol, but also from cardiovascular diseases.

In this study, we analysed prospective follow—up data from Novosibirsk, Russia, to investigate the effect of binge drinking on cardiovascular mortality. Novosibirsk is the third—largest city in Russia (population 1–4 million) and is the industrial centre of western Siberia. In respect of mortality trends, social and economic characteristics, ethnic composition, lifestyle, and drinking habits, Novosibirsk is regarded as fairly typical of the Russian Federation.13, 14, 15

Section snippets

Methods

The study was undertaken in two administrative districts (population 300 000) of Novosibirsk as part of the WHO MONICA (monitoring trends and determinants in cardiovascular disease) project.16 The cohort was a random sample in the two districts of male residents, aged 25–64 years, who were examined in cross—sectional surveys: a pilot study in 1984 (n=1603) and three MONICA surveys in 1985–86 (1573), 1988–89 (1721), and 1994–95 (1605). The response rates ranged from 71% to 73%. Participants gave

Results

Table 1 shows the baseline characteristics of men included in the study. Frequency of drinking was low—only 8% of men reported that they drank three or more times a week—but the mean typical dose per occasion was high at 91 g ethanol. Correspondingly, 55% (n=3486) of men drank 80 g or more and 16% (1005) drank 160 g or more alcohol per occasion. All indices of alcohol consumption were strongly associated with smoking; for example, prevalence of smoking was 41% (n=264) among non—drinkers and 69%

Discussion

In this study in Russia, episodic binge drinking was not related to a significantly increased risk of death from coronary heart disease after controlling for smoking. However, we noted an increased risk of death from cardiovascular disease and coronary heart disease in a small group of frequent heavy drinkers.

The main strength of this study lies in the selection of the study population. The study was done in a representative sample of the Russian urban population, and response rates were

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