Preventive cardiology
Alcohol Drinking and Cardiovascular Risk in a Population With High Mean Alcohol Consumption

https://doi.org/10.1016/j.amjcard.2008.09.089Get rights and content

Moderate alcohol consumption has been associated with lower coronary artery disease (CAD) risk. However, data on the CAD risk associated with high alcohol consumption are conflicting. The aim of this study was to examine the impact of heavier drinking on 10-year CAD risk in a population with high mean alcohol consumption. In a population-based study of 5,769 adults (aged 35 to 75 years) without cardiovascular disease in Switzerland, 1-week alcohol consumption was categorized as 0, 1 to 6, 7 to 13, 14 to 20, 21 to 27, 28 to 34, and ≥35 drinks/week or as nondrinkers (0 drinks/week), moderate (1 to 13 drinks/week), high (14 to 34 drinks/week), and very high (≥35 drinks/week). Blood pressure and lipids were measured, and 10-year CAD risk was calculated according to the Framingham risk score. Seventy-three percent (n = 4,214) of the participants consumed alcohol; 16% (n = 909) were high drinkers and 2% (n = 119) very high drinkers. In multivariate analysis, increasing alcohol consumption was associated with higher high-density lipoprotein cholesterol (from a mean ± SE of 1.57 ± 0.01 mmol/L in nondrinkers to 1.88 ± 0.03 mmol/L in very high drinkers); triglycerides (1.17 ± 1.01 to 1.32 ± 1.05 mmol/L), and systolic and diastolic blood pressure (127.4 ± 0.4 to 132.2 ± 1.4 mm Hg and 78.7 ± 0.3 to 81.7 ± 0.9 mm Hg, respectively) (all p values for trend <0.001). Ten-year CAD risk increased from 4.31 ± 0.10% to 4.90 ± 0.37% (p = 0.03) with alcohol use, with a J-shaped relation. Increasing wine consumption was more related to high-density lipoprotein cholesterol levels, whereas beer and spirits were related to increased triglyceride levels. In conclusion, as measured by 10-year CAD risk, the protective effect of alcohol consumption disappears in very high drinkers, because the beneficial increase in high-density lipoprotein cholesterol is offset by the increases in blood pressure levels.

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Methods

This cross-sectional study examined participants in the Cohorte Lausannoise (CoLaus) study, a population-based study of 6,187 Caucasian community-dwelling men and women aged 35 to 75 years. Participants were selected from a random sample of all age-eligible adults living in the city of Lausanne, Switzerland (population 117,161). The details of eligibility criteria have been described previously.1 All participants gave written informed consent and the institutional review board in Lausanne

Results

The baseline characteristics of the participants are listed in Table 1. About three quarters of the participants (73%) consumed alcohol, and more than half (55%) had moderate consumption (1 to 13 drinks/week); 16% had high consumption (14 to 34 drinks/week), and 2% had very high consumption (≥35 drinks/week). Wine was the most frequent beverage type consumed, and beer consumption was predominant in men. Women were less likely to be in the high or very high alcohol consumption groups and,

Discussion

In this population-based study including a substantial proportion of high drinkers, increasing alcohol consumption was associated with higher HDL cholesterol levels but also with increased levels of total cholesterol and triglycerides and increased blood pressure values, resulting in a J-shaped relation with 10-year CAD risk. The protective effect of alcohol on CAD risk disappears because the increase in blood pressure offsets the benefits of the increase in HDL cholesterol.

A previous

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    This study was supported by research grants from the Faculty of Biology and Medicine of Lausanne, Switzerland, and from GlaxoSmithKline, Philadelphia, Pennsylvania.

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