Alcohol Consumption and Risk of Coronary Heart Disease in Diabetic Patients

abstracts & commentary

Synopsis: The findings in both of these studies suggest that light to moderate alcohol intake is associated with a slightly more than 50% reduction in the risk of developing symptomatic CHD. The positive effect among diabetics of either sex was comparable to that seen in the general population.

Sources: Ajani UA, et al. Circulation 2000;102:500-505; Solomon CG, et al. Circulation 2000;102:494-499.

Coronary heart disease (chd) is a major cause of morbidity and mortality in diabetics, in fact, CHD was listed as a cause of death on at least 69% of death certificates of diabetic patients.1 Epidemiologic studies have consistently reported that moderate alcohol consumption significantly reduces the risk for CHD incidences and mortality2-4 in the general population. Until now, a similar association between consumption of alcohol and occurrence of CHD among individuals with diabetes had not been demonstrated.

Ajani and associates from Harvard Medical School and several teaching hospitals in the Boston area examined the records of 87,938 U.S. physicians (2790 with diagnosis mellitus) who were participating in the Physicians’ Health Study. In the same issue of Circulation, Solomon and colleagues from the Harvard School of Public Health reported on the results of their evaluation of a prospective cohort study of 121,700 female nurses; they evaluated 39,092 person-years of follow-up in women who reported a diagnosis of diabetes mellitus. The results of both of these studies strongly suggested that light to moderate alcohol consumption is associated with risk reductions in CHD occurrence among diabetic patients that were similar to those which have been demonstrated to occur in the nondiabetic population.

COMMENT by Harold L. Karpman, MD

The effects of light to moderate daily alcohol consumption were similar among men in the Ajani et al study as they were among women in the Solomon et al study. The findings in each of these studies suggest that light to moderate alcohol intake is associated with a slightly more than 50% reduction in the risk of developing symptomatic CHD. The positive effect among diabetics of either sex was comparable to that seen in the general population.5-7

The beneficial effect of alcohol on CHD risk in individuals with Type II diabetes mellitus may be due to the favorable effects of alcohol consumption on serum lipids,8,9 on decreasing platelet aggregation,10 and/or on increasing fibrolytic activity.11 These mechanisms may even be more important in a diabetic population than in the general population because dyslipidemia and coagulation disorders are more prevalent in diabetics. In addition, it is possible that alcohol may reduce insulin in diabetics afflicted with hyperinsulinemia,12 which could result in a decrease in the risk of CHD.

In conclusion, light to moderate alcohol consumption has been demonstrated in these two prospective cohort studies to significantly reduce the risk of CHD morbidity and mortality similarly among men and women, whether or not they are afflicted with diabetes. Because modest alcohol consumption appears to have a favorable cardiovascular effect in diabetics, it should not be routinely discouraged in the diabetic population; however, in light of major clinical and public health problems associated with heavy drinking, recommendations regarding alcohol use, no matter how beneficial, must be made on an individual basis after carefully assessing the risks and benefits of any changes in drinking behavior in that individual. If alcohol consumption can be limited to only a light or moderate daily intake, both diabetic and nondiabetic patients of both sexes will benefit by the significant reduction in CHD morbidity and mortality.

References

1. Gu K, et al. Diabetes Care 1998;21:1138-1145.

2. Alcohol and the Cardiovascular System. Research Monograph 31. Bethesda, Md. National Institute on Alcohol Abuse and Alcoholism;1996.

3. Rimm EB, et al. Lancet 1991;338:464-468.

4. Camargo CA Jr, et al. Arch Intern Med 1997;157:
79-85.

5. Valmadrid CT, et al. JAMA 1999;282:239-246.

6. Thulaseedharan N, Augusti KT. Indian Heart J 1995; 47:471-476.

7. Rosengren A, et al. BMJ 1989;299:1127-1131.

8. Gaziano JM, et al. N Engl J Med 1993;329:1829-1834.

9. Hulley SB, Gordon S. Circulation 1981;64(3 Pt 2):III-57-63.

10. Rubin R, Rand MI. Alcohol Clin Exp Res 1994;18:
105-110.

11. Ridker PM, et al. JAMA 1994;272:929-933.

12. Feskens EJ, Kromhout D. Arterioscler Thromb 1994; 14:1641-1647.