Systemic hypertension
Alcohol Consumption and Heart Failure in Hypertensive US Male Physicians

https://doi.org/10.1016/j.amjcard.2008.04.031Get rights and content

Although alcohol drinking increases blood pressure and heavy drinking has been associated with alcoholic cardiomyopathy, little is known about the association between light to moderate drinking and risk of heart failure (HF) in hypertensive subjects. Thus, the association between light to moderate drinking and incident HF in 5,153 hypertensive male physicians who were free of stroke, myocardial infarction, or major cancers at baseline was prospectively examined. Alcohol consumption was self-reported and classified as <1, 1 to 4, 5 to 7, and ≥8 drinks/week. HF was ascertained using follow-up questionnaires and validated using Framingham criteria. Average age was 58 years, and about 70% of subjects consumed 1 to 7 drinks/week. A total of 478 incident HF cases occurred in this cohort during follow-up. Compared with subjects consuming <1 drink/week, hazard ratios for HF were 0.89 (95% confidence interval [CI] 0.70 to 1.12), 0.72 (95% CI 0.57 to 0.91), and 0.38 (95% CI 0.20 to 0.72) for alcohol consumption of 1 to 4, 5 to 7, and ≥8 drinks/week after adjustment for age, body mass index, smoking, randomization group, use of multivitamins, vegetable consumption, breakfast cereal, exercise, and history of atrial fibrillation, respectively (p for trend <0.001). Similar results were obtained for subjects with HF with and without antecedent myocardial infarction and those without diabetes mellitus. In conclusion, our data suggested that light to moderate alcohol consumption was associated with a lower risk of HF in hypertensive male physicians.

Section snippets

Methods

We used data from the Physicians' Health Study (PHS) I, a randomized trial of aspirin and β carotene for the primary prevention of cardiovascular disease and cancer in 22,071 US male physicians. A detailed description of the PHS I has been published previously.10 At baseline, subjects were asked (1) to report their present blood pressure (item 13.a of the questionnaire) and (2) whether they had ever received drug treatment for hypertension (possible answers were never, past only, or present;

Results

Of 5,153 PHS subjects who reported prevalent hypertension at baseline, mean age at randomization was 58 ± 10 years (range 40 to 86). About 70% of subjects consumed 1 to 7 drinks/week, and only 4% reported consumption of ≥8 drinks/week. Table 1 lists baseline characteristics of study subjects. During an average follow-up of 18 years, 478 new cases of HF occurred in this cohort. In a multivariable Cox regression model, alcohol consumption was associated with a lower risk of HF in a dose–response

Discussion

In this cohort of hypertensive US male physicians, we found that light to moderate alcohol consumption was associated with a lower risk of HF. Furthermore, the inverse relation between light to moderate alcohol consumption and HF was observed for patients with HF with and without antecedent myocardial infarction. This was the first study to report an association between light to moderate drinking and risk of HF in hypertensive subjects.

Previous studies showed that excessive drinking was

Acknowledgments

We thank the PHS subjects for outstanding commitment and cooperation and the entire PHS staff for expert and unfailing assistance.

References (28)

  • M.J. Klag et al.

    Validity of physicians' self-reports of cardiovascular disease risk factors

    Ann Epidemiol

    (1993)
  • C.R. Walsh et al.

    Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study

    Ann Intern Med

    (2002)
  • J.L. Abramson et al.

    Moderate alcohol consumption and risk of heart failure among older persons

    JAMA

    (2001)
  • L. Djousse et al.

    Alcohol consumption and risk of heart failure in the Physicians' Health Study I

    Circulation

    (2007)
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    The Physicians' Health Study was supported by Grants No. CA-34944, CA-40360, and CA-097193 from the National Cancer Institute, Bethesda, Maryland, and Grants No. HL-26490 and HL-34595 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Dr. Djoussé is Principal Investigator on a K01 HL-70444 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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