Cancer or Heart Disease? Drinkers May Need to Choose

Abstract & Commentary

By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.

Synopsis: Moderate alcohol intake was associated with longer survival and better quality of life scores for Australian women age 70-75 years old, while non-drinkers had greater risk of death and poorer health-related quality.

Source: Byles J, et al. A Drink to Healthy Aging: The Association Between Older Women's Use of Alcohol and Their Health-Related Quality of Life. J AM Geriatr Soc. 2006:54;1341-1347.

Using self-reported survey data from the Australian Longitudinal Study on Women's Health, 11,800 women aged 70-75 years who were randomly selected from the national insurance database completed questionnaires from 1996 through 2002 at three year intervals. These were used to measure alcohol consumption and health-related quality of life, and the computer database provided information on mortality as well as risk behaviors. Low-to-moderate alcohol intake was defined as 1-14 drinks/week, and this group was further subdivided into 4 subgroups depending on weekly quantity. Sequential surveys found there was little quantity change over the years in the 69% who drank rarely or at low levels.

Higher mortality (death rate, 0.019/person-year) was found in the 29% of women who rarely or never drank alcohol, compared to women with low regular intake (lowest death rate, 0.010 for 3-12 drinks/week) after adjustment for smoking, comorbidity, education, BMI, and area of residence. High intake of 15 or more drinks/week had the highest death rate (0.024/person-year). Individual questionnaires provided eight subscales of health status and quality of life that were averaged into one score that also showed the same associations with quantity of alcohol consumed.

Commentary

Is it surprising that we continue to be interested in showing benefit from alcohol drinking? Regular drinkers may rejoice in this Australian study of older women which not only shows better quality of life in moderate drinkers, but also suggests non-drinkers are more likely to die, and if they survive do not enjoy life as much as drinkers.

While other studies have also supported lower cardiovascular risk and many other benefits with moderate alcohol drinking in both men and women, others point out that alcohol use is only an association and not a cause of these outcomes.1 Non-drinkers may have other health problems or take medications contraindicated with alcohol, and studies are not randomized. Not all results agree, and there are many problems with underreporting of alcohol consumption when self-report is used.

Unfortunately the benefits of alcohol consumption do not seem to apply to cancer prevention. The American Cancer Society has just issued nutritional guidelines that limit alcohol to one drink or less daily for women (two for men) to prevent cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.2 A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. They point out that cardiovascular disease can be reduced in many other ways, and that there is no reason for non-drinkers to begin drinking.

References

1. Naimi TS, et al. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med. 2005;28:369-373.

2. Kushi LH. American cancer society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2006;56:254-281.