title: Changes in alcohol intake and risk of coronary heart disease and all-cause mortality in the MONICA/KORA-Augsburg cohort 1987-97.
abstract: BACKGROUND
  : Most studies on the effect of alcohol consumption on coronary heart disease or all-cause mortality assess alcohol intake at one point in time and therefore do not take into consideration changes in drinking habits over time. We investigate whether a second assessment of alcohol intake substantially improves estimation of the effects of alcohol intake on these outcomes.
  
  
  METHODS
  : A prospective cohort study of 2710 men and women, age 35-64 years at baseline in 1984/85 in the Augsburg region in southern Germany. We recorded incident fatal and non-fatal coronary events and all-cause mortality until 1997. Alcohol intake and other explanatory variables were assessed in 1984/85 and 1987/88.
  
  
  METHODS
  : Based on these assessments, participants were classified as non-drinkers, quitters, starters and constant drinkers. We calculated hazard rate ratios for coronary events and all-cause mortality in these groups and adjusted for several potential confounders using Cox's proportional hazards model. These estimates were compared with hazard rate ratios based on a single assessment of alcohol intake in 1987/88.
  
  
  RESULTS
  : Among male constant drinkers the adjusted hazard rate ratio (HRR) for coronary events was lowest among those consuming 0.1-19.9 g alcohol per day, compared with non-drinkers [HRR 0.29; 95% confidence interval (CI) 0.12-0.70]. The lowest all-cause mortality risk was observed among men drinking 20.0-39.9 g per day (HRR 0.48; 95% CI 0.26-0.88). In female constant drinkers the HRR for all-cause mortality was 0.71 (95% CI 0.40-1.26) for those reporting 0.1-19.9 g daily alcohol consumption. Hazard rate ratios for alcohol intake classified by two assessments consistently revealed a more pronounced beneficial effect of alcohol consumption than those for alcohol intake groups based on a single measurement.
  
  
  CONCLUSIONS
  : Assessment of alcohol intake at two points in time seems slightly to improve the risk estimation for coronary heart disease (CHD) and for all-cause mortality, compared with a single measurement. Thus, our findings strengthen the evidence of a beneficial effect of light to moderate alcohol consumption on coronary heart disease and all-cause mortality.
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wellmann
authors.forename: Jan
authors.initials: J
authors.lastname: Heidrich
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.forename: Angela
authors.initials: A
authors.lastname: Döring
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keil
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D002423:Cause of Death; D002492:Central Nervous System Depressants / Q000008:administration & dosage; D003327:Coronary Disease / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000453:epidemiology
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol