Alcohol Consumption and Mortality in Patients with CVD

Abstract & Commentary

By Harold L. Karpman, MD, FACC, FACP, Clinical Professor of Medicine, UCLA School of Medicine. Dr. Karpman serves on the speakers bureau for Forest Laboratories.

Synopsis: In patients with cardiovascular disease, light-to- moderate alcohol consumption is significantly associated with a lower incidence of cardiovascular and all-cause mortality.

Source: Costanzo S, et al. Alcohol consumption and mortality in patients with cardiovascular disease: A meta analysis. J Am Coll Cardiol 2010;55:1339-1347.

Numerous published studies have revealed that ischemic cardiovascular events and/or all-cause mortality are significantly increased even in apparently healthy individuals who consume an excessive amount of alcohol and are significantly reduced in those individuals who regularly consume only small-to-moderate quantities of alcohol.1-6 However, it should be noted that relatively few observational studies have evaluated the association between alcohol intake and secondary events including mortality in patients with cardiovascular disease (CVD), and the results in even these few studies have consistently revealed a reduction in the all-cause mortality risk in subjects who were light or moderate consumers of alcohol.7,8

Costanzo and colleagues extended the results of previous analyses8 by evaluating more recent studies, which correlated alcohol intake by patients with established CVD with cardiovascular and/or overall mortality. They identified 54 studies but restricted their analysis to the results of only 8 major prospective studies that enrolled a total of 16,351 patients with a history of CVD. The meta-analysis on cardiovascular mortality revealed a J-shaped curve with a significant maximal protection (i.e., a significantly lower incidence of cardiovascular and all-cause mortality) when subjects consumed light-to-moderate amounts of alcohol in the range of approximate 5-25 g/day.

Commentary

The 2006 Diet and Lifestyle Recommendations Scientific Statement from the American Heart Association Nutrition Committee clearly advises: "If you consume alcohol, do so in moderation (equivalent of no more than one drink for women or two drinks for men per day)."9 This recommendation has been widely accepted and has been considered to be quite valid for patients with known CVD as well as for healthy individuals. Costanzo and colleagues have now clearly demonstrated that the same recommendation remains current and can be appropriately extended to CVD patients; however, due to the lack of controlled intervention trials, which are both difficult to perform and ethically questionable, cardiovascular patients who do not regularly consume alcoholic beverages should not necessarily be advised to initiate alcohol consumption, even though the benefits have been clearly demonstrated. On the other hand, heavy or binge alcohol drinkers, whether they have associated CVD or not, should be strongly advised to totally abstain or to at least decrease their alcohol consumption to no more than a moderate level of intake.

In summary, physicians should be aware that the regular intake of a light-to-moderate amount of alcohol, especially if it is consumed as part of a healthy lifestyle (i.e., increased physical activity, no smoking, etc.) in subjects who are following a healthy dietary regimen (i.e., decreased dietary fat intake, high consumption of fruit and vegetables), and who receive appropriate drug therapy, will help substantially diminish the level of cardiovascular and/or all-cause mortality risk to a level which is substantially lower than exists in either alcohol abstainers or heavy alcohol drinkers.

References

1. Di Castelnuovo A, et al. Meta-analysis of wine and beer consumption in relation to vascular risk. Circulation 2002;105:2836-2844.

2. Corrao G, et al. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004;38:613-619.

3. Reynolds K, et al. Alcohol consumption and the risk of stroke: A meta analysis. JAMA 2003;289:579-588.

4. Corrao G, et al. Alcohol and coronary heart disease: A meta-analysis. Addiction 2000;95:1505-1523.

5. Di Castelnuovo A, et al. Alcohol dosing and total mortality in men and women: An updated meta-analysis of 34 prospective studies. Arch Intern Med 2006;166:2437-2445.

6. White IR, et al. Alcohol consumption and mortality: Modelling risks for men and women at different ages. BMJ 2002;325:191.

7. Makamal KJ, et al. Alcohol use and prognosis in patients with coronary heart disease. Prev Cardiol 2003;6:93-98.

8. Iestra JA, et al. Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: A systematic review. Circulation 2005;112:924-934.

9. Lichtenstein AH, et al. Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart association nutrition committee. Circulation 2006;114:82-96.