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Rimm, Eric B; Klatsky, Arthur; Grobbee, Diederick; Stampfer, Meir J
doi: 10.1136/bmj.312.7033.731pmid: 8605457
Abstract Objectives: To review the effect of specific types of alcoholic drink on coronary risk. Design: Systematic review of ecological, case-control, and cohort studies in which specific associations were available for consumption of beer, wine, and spirits and risk of coronary heart disease. Subjects: 12 ecological, three case-control, and 10 separate prospective cohort studies. Main outcome measures: Alcohol consumption and relative risk of morbidity and mortality from coronary heart disease. Results: Most ecological studies suggested that wine was more effective in reducing risk of mortality from heart disease than beer or spirits. Taken together, the three case-control studies did not suggest that one type of drink was more cardioprotective than the others. Of the 10 prospective cohort studies, four found a significant inverse association between risk of heart disease and moderate wine drinking, four found such an association for beer, and four for spirits. Conclusions: Results from observational studies, where alcohol consumption can be linked directly to an individual's risk of coronary heart disease, provide strong evidence that all alcoholic drinks are linked with lower risk. Thus, a substantial portion of the benefit is from alcohol rather than other components of each type of drink. Key messages Key messages We examined the relation between specific alcoholic drinks and reduction of risk of coronary heart disease by summarising published reports from ecological, case-control, and cohort studies Most ecological studies suggested that wine was more effective in reducing risk of mortality than beer or spirits, whereas the three case-control studies together did not suggest that one type of drink was more cardioprotective than others Of the 10 prospective cohort studies, four found a significant inverse association between risk of heart disease and moderate wine drinking, four found the association for beer, and four found it for spirits. The evidence suggests that all alcoholic drinks are linked with lower risk, so that much of the benefit is from alcohol rather than other components of each type of drink
Hein, Hans Ole; Suadicani, Poul; Gyntelberg, Finn
doi: 10.1136/bmj.312.7033.736pmid: 8605458
Abstract Objectives: To investigate the interplay between use of alcohol, concentration of low density lipoprotein cholesterol, and risk of ischaemic heart disease. Design: Prospective study with controlling for several relevant confounders, including concentrations of other lipid fractions. Setting: Copenhagen male study, Denmark. Subjects: 2826 men aged 53-74 years without overt ischaemic heart disease. Main outcome measure: Incidence of ischaemic heart disease during a six year follow up period. Results: 172 men (6.1%) had a first ischaemic heart disease event. There was an overall inverse association between alcohol intake and risk of ischaemic heart disease. The association was highly dependent on concentration of low density lipoprotein cholesterol. In men with a high concentration (>/=5.25 mmol/l) cumulative incidence rates of ischaemic heart disease were 16.4% for abstainers, 8.7% for those who drank 1-21 beverages a week, and 4.4% for those who drank 22 or more beverages a week. With abstainers as reference and after adjustment for confounders, corresponding relative risks (95% confidence interval) were 0.4 (0.2 to 1.0; P<0.05) and 0.2 (0.1 to 0.8; P<0.01). In men with a concentration <3.63 mmol/l use of alcohol was not associated with risk. The attributable risk (95% confidence interval) of ischaemic heart disease among men with concentrations >/=3.63 mmol/l who abstained from drinking alcohol was 43% (10% to 64%). Conclusions: In middle aged and elderly men the inverse association between alcohol consumption and risk of ischaemic heart disease is highly dependent on the concentration of low density lipoprotein cholesterol. These results support the suggestion that use of alcohol may in part explain the French paradox. Key messages Key messages The low risk of ischaemic heart disease in men with a low concentration of serum low density lipoprotein cholesterol was not modified by use of alcohol The risk of ischaemic heart disease in men with a high concentration of serum low density lipoprotein cholesterol was strongly modified by use of alcohol: those who did not drink alcohol had five times the risk of ischaemic heart disease compared with those who consumed three alcoholic beverages or more a day The results support the hypothesis that the apparent discrepancy between a low risk of ischaemic heart disease and a high intake of fat, a phenomenon known as the French paradox, may partly be explained by consumption of alcohol In studies of the use of alcohol and risk of ischaemic heart disease, serum low density lipoprotein cholesterol should be regarded as a potentially strong effect modifier not as a potential confounder
Goodfellow, Jonathan; Ramsey, Mark W; Luddington, Lisa A; Jones, Christopher J H; Coates, Phillip A; Dunstan, Frank; Lewis, Malcolm J; Owens, David R; Henderson, Andrew H
doi: 10.1136/bmj.312.7033.744pmid: 8605460
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